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Objectives  Patients with a vestibular schwannoma (VS) experience a reduced quality of life (QoL). The main objective of this study was to determine the strongest predictors reducing physical and mental QoL from the disease‐specific Penn Acoustic Neuroma Quality of Life (PANQOL) questionnaire in patients with VS.    Design  Observational study.    Setting  Radboudumc Skull Base Centre, Nijmegen.    Participants  Patients newly diagnosed with VS between 2014 and 2017 managed with either observation, stereotactic radiosurgery or microsurgery.    Main outcome measures  Quality of life was assessed using the disease‐specific PANQOL and general Short‐Form (36) Health Survey (SF‐36). Multiple linear regression models with PANQOL domains as predictors were used to determine the strongest predictors for SF‐36 QoL physical and mental health scores. Standardised beta coefficients ( β ) were used for ranking.    Results  A total of 174 patients (50% females, mean age 58.9 years) returned the questionnaires, providing a 69% response rate. Fifteen patients (9%) were treated with microsurgery, 29 (17%) with stereotactic radiosurgery and 130 patients (75%) were observed in a wait and scan strategy. A lack of energy ( β  = .28;  P  ≤ .001), lower general health ( β  = .22;  P  ≤ .001), headache ( β  = .16;  P  ≤ .001), anxiety ( β  = .15;  P  ≤ .001) and balance problems ( β  = .10;  P  ≤ .001) are the strongest predictors affecting physical health, while mental health is most affected by anxiety ( β  = .37;  P  ≤ .001), a lack of energy ( β  = .34;  P  ≤ .001), facial nerve dysfunction ( β  = .07;  P  ≤ .001), balance problems ( β  = .04;  P  ≤ .001) and headaches ( β  = .04;  P  ≤ .001).    Conclusion  A lack of energy, anxiety, headache and balance problems are the strongest predictors of both SF‐36 physical and mental QoL in patients with VS. More awareness and supportive care regarding energy, anxiety, headache and balance in informing, evaluating and treating patients with VS could improve QoL.

What determines quality of life in patients with vestibular schwannoma?