前庭神经切断术前、后神经鞘瘤患者的人体前庭眼反射和代偿性扫视。
The human vestibulo-ocular reflex and compensatory saccades in schwannoma patients before and after vestibular nerve section.
机构信息
Sydney Medical School, The University of Sydney, Sydney, Australia; Institute of Clinical Neurosciences, Royal Prince Alfred Hospital, Sydney, Australia; Otolaryngology, Head, Neck and Skull Base Surgery Department, St Vincent's Hospital, Sydney, Australia.
Institute of Clinical Neurosciences, Royal Prince Alfred Hospital, Sydney, Australia; Department of Physiology, University of Auckland, Auckland, New Zealand.
出版信息
Clin Neurophysiol. 2022 Jun;138:197-213. doi: 10.1016/j.clinph.2022.02.014. Epub 2022 Mar 1.
OBJECTIVE
To examine the vestibulo-ocular reflex (VOR) and compensatory-saccades before and after complete unilateral vestibular deafferentation (UVD).
METHODS
Forty patients were studied before and after surgery for vestibular or facial schwannoma using the video head-impulse test (vHIT) and multivariable regression.
RESULTS
Prior to UVD (median(IQR), 14(58.4) days), the average VOR-gain towards the lesioned-ear was lower than in normal for all semicircular canals (lateral, anterior, posterior: 0.69, 0.72, 0.49). One-week after UVD (5(3.0) days) VOR gains were further reduced (0.22, 0.37, 0.27), however, within one-year after UVD (171(125.0) days) the lesioned-ear VOR gains had slightly increased (+0.08, +0.11, +0.03), maximally for the anterior-canal. After UVD, the VOR gain asymmetry (gain towards minus away from intact-ear) was lower for the intact posterior-canal plane (0.56, 0.56, 0.22). For the lesioned canals, the frequency and amplitude of the first compensatory-saccade increased from 61-93% and 1.9-3.6° pre-surgery, to 98-99% and to 3.1-5.9° one-week post-surgery and remained unchanged over one-year; second saccade frequency and amplitude decreased over the same timespan.
CONCLUSIONS
After UVD the high-acceleration VOR for the intact posterior-canal plane is more symmetrical than the other canals. First compensatory-saccades adapt within one week and subsequently change only marginally.
SIGNIFICANCE
Saccade compensation from surgical UVD is near complete by one-week.
目的
研究完全单侧前庭神经切断（UVD）前后前庭眼反射（VOR）和代偿性扫视。
方法
40 例前庭或面神经神经鞘瘤患者，使用视频头脉冲试验（vHIT）和多变量回归进行手术前后研究。
结果
在 UVD 之前（中位数（IQR），14（58.4）天），所有半规管的病变耳 VOR 增益均低于正常（外侧、前侧、后侧：0.69、0.72、0.49）。UVD 后一周（5（3.0）天）VOR 增益进一步降低（0.22、0.37、0.27），但 UVD 后一年（171（125.0）天）病变耳 VOR 增益略有增加（0.08、0.11、0.03），最明显的是前侧管。UVD 后，完整后颅管平面的 VOR 增益不对称性（朝向和远离完整耳的增益）较低（0.56、0.56、0.22）。对于病变管，第一次代偿性扫视的频率和幅度从术前的 61-93%和 1.9-3.6°增加到术后一周的 98-99%和 3.1-5.9°，并在一年后保持不变；第二次扫视的频率和幅度在同一时间段内下降。
结论
UVD 后，完整后颅管平面的高加速度 VOR 比其他管更对称。第一次代偿性扫视在一周内适应，随后仅略有变化。
意义
手术后一周内，UVD 的扫视补偿几乎完全。
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