Fellmann Jonas, Bächinger David, Dalbert Adrian, Röösli Christof, Huber Alexander, Wettstein Vincent G
Department of Otorhinolaryngology, Head and Neck Surgery, University Hospital Zurich, Zurich, Switzerland.
University of Zurich, Zurich, Switzerland.
J Vestib Res. 2022;32(1):49-56. doi: 10.3233/VES-200023.
Surgical treatment of vestibular schwannoma (VS) leads to acute ipsilateral vestibular loss if there is residual vestibular function before surgery. To overcome the sequelae of acute ipsilateral vestibular loss and to decrease postoperative recovery time, the concept of preemptive vestibular ablation with gentamicin and vestibular prehabilitation before surgery has been developed ("vestibular prehab").
Studying postural stability during walking and handicap of dizziness over a 1-year follow-up period in VS patients undergoing vestibular prehab before surgical treatment of VS.
A retrospective review of consecutive patients with a diagnosis of a VS undergoing surgical therapy from June 2012 to March 2018 was performed. All patients were included with documentation of the length of hospital duration and the Dizziness Handicap Inventory (DHI) and the Functional Gait Assessment (FGA) assessed preoperatively as well as 6 weeks and 1 year postoperatively.
A total 68 VS patients were included, of which 29 patients received preoperative vestibular ablation by intratympanic injection of gentamicin. Mean VS diameter was 20.2 mm (SD 9.4 mm) and mean age at surgery was 49.6 years (SD 11.5 years). Vestibular prehab had no effect on DHI and FGA at any time point studied.
We found no effect of vestibular prehab on postural stability during walking and on the handicap of dizziness. These findings add to the body of knowledge consisting of conflicting results of vestibular prehab. Therefore, vestibular prehab should be applied only in selected cases in an experimental setting.
如果术前存在残余前庭功能，前庭神经鞘瘤（VS）的手术治疗会导致同侧急性前庭功能丧失。为了克服急性同侧前庭功能丧失的后遗症并缩短术后恢复时间，已提出在手术前使用庆大霉素进行前庭预消融和前庭康复训练的概念（“前庭预康复”）。
研究在VS手术治疗前接受前庭预康复的VS患者在1年随访期内行走时的姿势稳定性和头晕障碍情况。
对2012年6月至2018年3月期间连续诊断为VS并接受手术治疗的患者进行回顾性研究。所有患者均纳入研究，记录住院时间、术前以及术后6周和1年评估的头晕障碍量表（DHI）和功能性步态评估（FGA）。
共纳入68例VS患者，其中29例患者通过鼓室内注射庆大霉素接受了术前前庭消融。VS平均直径为20.2毫米（标准差9.4毫米），手术时平均年龄为49.6岁（标准差11.5岁）。在前庭预康复研究的任何时间点，其对DHI和FGA均无影响。
我们发现前庭预康复对行走时的姿势稳定性和头晕障碍没有影响。这些发现进一步丰富了关于前庭预康复结果相互矛盾的知识体系。因此，前庭预康复应仅在实验环境下的特定病例中应用。
