Dong Jiaoxuan, Li Ling, He Songbin, Liu Haipeng, Dai Fangyu
Department of Neurology, Zhoushan Hospital, Wenzhou Medical University, Zhoushan, China.
Research Centre for Intelligent Healthcare, Coventry University, Coventry, United Kingdom.
Front Neurol. 2022 Jun 10;13:902758. doi: 10.3389/fneur.2022.902758. eCollection 2022.
Several canalith repositioning procedures (CRPs) such as Gufoni maneuver have been proposed to treat the apogeotropic lateral semicircular canal variant of BPPV (LC-BPPV). The reported success rate varied widely in different studies. Research showed that there was a risk of treatment failure due to insufficient repositioning of the debris. So far, there is insufficient evidence to recommend a preferable CRP for apogeotropic LC-BPPV.
A 49-year-old woman and a 48-year-old man diagnosed with apogeotropic LC-BPPV relapse were treated with original Gufoni maneuver for apogeotropic variant but no satisfactory result was obtained. A variation of Gufoni maneuver originally proposed for the geotropic variant was applied to detach otoconia toward the utricle or the non-ampullary arm. Apogeotropic nystagmus was successfully transformed into the geotropic variant. The subsequent Gufoni maneuver was successful. On a 64-year-old male with untreated apogeotropic LC-BPPV, we performed the Gufoni maneuver variation and observed a change in nystagmus direction. In all the three cases, no relapse of vertigo was reported after 1 month.
The new application of Gufoni maneuver variation may improve the treatment of apogeotropic LC-BPPV. Treatment efficacy and patient-specific optimization such as head rotation angle deserve a large-scale validation and further investigation.
已经提出了几种耳石复位程序（CRP），如古福尼手法，用于治疗背地性后半规管良性阵发性位置性眩晕（LC-BPPV）。不同研究报道的成功率差异很大。研究表明，由于碎片复位不足存在治疗失败的风险。到目前为止，没有足够的证据推荐一种更适合背地性LC-BPPV的CRP。
一名49岁女性和一名48岁男性被诊断为背地性LC-BPPV复发，接受了针对背地性变体的原始古福尼手法治疗，但未获得满意结果。一种最初为地向性变体提出的古福尼手法变体被用于将耳石向椭圆囊或非壶腹臂分离。背地性眼震成功转变为地向性变体。随后的古福尼手法成功。在一名未经治疗的64岁背地性LC-BPPV男性患者中，我们进行了古福尼手法变体操作并观察到眼震方向改变。在所有这三例中，1个月后均未报告眩晕复发。
古福尼手法变体的新应用可能改善背地性LC-BPPV的治疗效果。治疗效果以及诸如头部旋转角度等针对患者的优化措施值得大规模验证和进一步研究。
