Tjernström F, Fransson P-A, Kahlon B, Karlberg M, Lindberg S, Siesjö P, Magnusson M
Department of Otorhinolaryngology, Head and Neck Surgery, Clinical Sciences, ENT Clinic, University Hospital Lund, Lund 22185, Sweden.
J Neurol Neurosurg Psychiatry. 2009 Nov;80(11):1254-60. doi: 10.1136/jnnp.2008.170878. Epub 2009 Jul 1.
Unilateral vestibular deafferentation (uVD), as performed in vestibular schwannoma surgery, results in a chronic vestibular deficit, though most of the insufficiency can be compensated by other sensory input. By vestibular training (prehabituation) performed before surgery, motor adaptation processes can be instigated before the actual lesion. The adaptation processes of the altered sensory input could be affected if the vestibular ablation and surgery were separated in time, by pretreating patients who have remaining vestibular function with gentamicin.
To determine whether presurgical deafferentation would affect postsurgery postural control also in a long-term perspective (6 months).
41 patients subjected to trans-labyrinthine schwannoma surgery were divided into four groups depending on the vestibular activity before surgery (with no clinical significant remaining function n = 17; with remaining function n = 8), whether signs of central lesions were present (n = 10), and if patients with remaining vestibular activity were treated with gentamicin with the aim to produce uVD before surgery (n = 6). The vibratory posturography recordings before surgery and at the follow-up 6 months after surgery were compared.
The subjects pretreated with gentamicin had significantly less postural sway at the follow-up, both compared with the preoperative recordings and compared with the other groups.
The results indicate that by both careful sensory training and separating the surgical trauma and the effects of uVD in time, adaptive processes can develop more efficiently to resolve sensory conflicts, resulting in a reduction of symptoms not only directly after surgery but also perhaps up to 6 months afterwards.
前庭神经鞘瘤手术中进行的单侧前庭去传入（uVD）会导致慢性前庭功能缺陷，尽管大部分功能不足可由其他感觉输入代偿。通过在手术前进行前庭训练（预适应），可在实际损伤前激发运动适应过程。如果通过用庆大霉素预处理仍保留前庭功能的患者，使前庭切除和手术在时间上分开，改变的感觉输入的适应过程可能会受到影响。
从长期（6个月）角度确定术前去传入是否也会影响术后姿势控制。
41例行迷路后神经鞘瘤手术的患者根据术前前庭活动情况（无临床显著残留功能n = 17；有残留功能n = 8）、是否存在中枢病变体征（n = 10）以及有残留前庭活动的患者是否用庆大霉素治疗以在术前产生uVD（n = 6）分为四组。比较手术前及术后6个月随访时的振动姿势描记图记录。
用庆大霉素预处理的受试者在随访时的姿势摆动明显小于术前记录，也小于其他组。
结果表明，通过仔细的感觉训练以及及时分离手术创伤和uVD的影响，适应过程可以更有效地发展以解决感觉冲突，不仅在手术后直接减轻症状，而且可能在术后长达6个月内减轻症状。
