Tjernström Fredrik, Fransson Per-Anders, Kahlon Babar, Karlberg Mikael, Lindberg Sven, Siesjö Peter, Magnusson Måns
Department of Otorhinolaryngology, Head and Neck Surgery, Skåne University Hospital, Lund, Sweden.
Department of Neurosurgery, Clinical Sciences, Skåne University Hospital, Lund, Sweden.
J Vestib Res. 2018;27(5-6):313-325. doi: 10.3233/VES-170626.
To evaluate post-surgical postural stability when treating patients with remaining vestibular function with intratympanic gentamicin (PREHAB) prior to schwannoma surgery.
44 consecutive patients with some form remaining vestibular function scheduled for vestibular schwannoma surgery. 20 were medically deafferented with intratympanic gentamicin before surgery and 24 were not. Both groups were of the same age, had the same tumor size, same type of surgery, and same perioperative sensory rehabilitation (training exercises), and no surgical complications. Postural stability measured as energy expenditure while standing on a force platform during vibratory stimulation of the calf muscles, performed prior to surgery (or gentamicin treatment) and 6 months after surgery.
Patients pretreated with gentamicin had significantly better postural stability at the time for follow-up (p < 0.05) and displayed a better adaptive capacity when faced with a postural challenge (p < 0.01). They were also able to use vision more efficiently to control their stability (p < 0.05).
By separating the sensory loss (through intratympanic gentamicin, that ablates the remaining vestibular function) from the intracranial surgical trauma, the postural control system benefited from a better short-term (adaptation) and long-term (habituation) recovery, when experiencing a postural challenge or resolving a sensory conflict. The benefits could be attributed to; active and continuous motor learning as the vestibular function slowly attenuates; no concomitant central nervous dysfunction due to effects from neurosurgery, thus allowing time for a separate unimpeded recovery process with more limited challenges and objectives; and the initiation and certain progression of sensory reweighting processes allowed prior to surgery. In contrast, worse compensation could be due to; immobilization from nausea after surgery, harmful amount of stress and cognitive dysfunction from the combination of surgical and sensory trauma and an abrupt vestibular deafferentation and its consequences on sensory reweighting.
评估在听神经瘤手术前，使用鼓室内庆大霉素（PREHAB）治疗仍保留前庭功能的患者时的术后姿势稳定性。
44例计划进行前庭神经鞘瘤手术且仍保留某种形式前庭功能的连续患者。20例在手术前接受了鼓室内庆大霉素化学去神经支配，24例未接受。两组患者年龄相同，肿瘤大小相同，手术类型相同，围手术期感觉康复（训练练习）相同，且无手术并发症。姿势稳定性通过在小腿肌肉振动刺激期间站在测力平台上时的能量消耗来测量，分别在手术前（或庆大霉素治疗前）和手术后6个月进行。
接受庆大霉素预处理的患者在随访时姿势稳定性明显更好（p<0.05），并且在面临姿势挑战时表现出更好的适应能力（p<0.01）。他们还能够更有效地利用视觉来控制稳定性（p<0.05）。
通过将感觉丧失（通过鼓室内庆大霉素消除剩余前庭功能）与颅内手术创伤分开，姿势控制系统在经历姿势挑战或解决感觉冲突时，从更好的短期（适应）和长期（习惯化）恢复中受益。这些益处可归因于：随着前庭功能缓慢减弱，主动且持续的运动学习；由于神经外科手术的影响，没有伴随的中枢神经功能障碍，从而允许有时间进行单独的、不受阻碍的恢复过程，且挑战和目标更有限；以及在手术前启动并确定了感觉重新加权过程的进展。相比之下，较差的代偿可能是由于：手术后因恶心而固定不动；手术和感觉创伤以及突然的前庭去神经支配及其对感觉重新加权的影响所导致的有害压力和认知功能障碍。
