Van Laer Lien, Hallemans Ann, Van Rompaey Vincent, De Valck Claudia, Van de Heyning Paul, Vereeck Luc
Department of Rehabilitation Sciences and Physiotherapy/Movant, Faculty of Medicine and Health Science, University of Antwerp, Antwerp, Belgium.
Multidisciplinary Motor Centre Antwerp (M2OCEAN), University of Antwerp, Antwerp, Belgium.
Front Neurol. 2022 Aug 19;13:925801. doi: 10.3389/fneur.2022.925801. eCollection 2022.
A vestibular schwannoma (VS) resection causes an acute unilateral vestibular deafferentation resulting in acute postoperative symptoms. Despite the expected resolution of most of the symptoms, due to central vestibular compensation, more than one out of four patients develop chronic dizziness. Several predictive factors, such as age and tumor size, have been suggested. Despite its potential effect on the process of central vestibular compensation, the level of physical activity after VS resection was not yet considered. Therefore, the association between the level of physical activity and chronic dizziness after VS resection will be investigated.
This retrospective cohort study included 66 patients who underwent a retro-sigmoid VS resection between October 2001 and February 2007. Patients were assessed before surgery and at 9 weeks and 6 months postoperatively. At 9 weeks, patients were asked to report their level of physical activity (PA) during the past week by using a visual analogue scale and their balance performance was assessed by four standing balance conditions with eyes closed and the Timed Up and Go test (TUG). Based on the Dizziness Handicap Inventory (DHI) score at 6 months, patients were divided in a chronic dizziness group (DHI > 30) and non-chronic dizziness group (DHI-score ≤ 30). Age, sex, Koos classification, preoperative vestibular function, treatment group, balance performance, and level of PA were compared between both groups and used as independent variables in linear regression analyses with the DHI score at 6 months as dependent variable.
The chronic dizzy patients revealed to have significantly lower levels of PA ( < 0.001) and worse static and dynamic balance performance ( = 0.023 and = 0.041, respectively) 9 weeks after surgery. After elimination, the multiple regression analysis resulted in a model with two variables (PA level, TUG) which significantly predicted the DHI score ( = 6.581; = 0.239; = 0.003).
This study revealed associations between (1) the level of PA and balance performance in the subacute phase and (2) chronic dizziness after VS resection. Assessment of the level of PA and balance performance during the subacute phase, which can be performed in a non-invasive and non-time-consuming way, might therefore provide prognostic information after VS resection.
前庭神经鞘瘤（VS）切除术会导致急性单侧前庭传入神经阻滞，从而引发急性术后症状。尽管多数症状有望因中枢前庭代偿而缓解，但仍有超过四分之一的患者会出现慢性头晕。已有多种预测因素被提出，如年龄和肿瘤大小等。尽管体力活动水平对中枢前庭代偿过程可能有影响，但VS切除术后的体力活动水平尚未被纳入考虑。因此，本研究将探讨VS切除术后体力活动水平与慢性头晕之间的关联。
这项回顾性队列研究纳入了2001年10月至2007年2月期间接受乙状窦后VS切除术的66例患者。在手术前以及术后9周和6个月对患者进行评估。在术后9周时，要求患者使用视觉模拟量表报告过去一周的体力活动（PA）水平，并通过四种闭眼站立平衡条件和定时起立行走测试（TUG）评估其平衡能力。根据6个月时的头晕残障量表（DHI）评分，将患者分为慢性头晕组（DHI>30）和非慢性头晕组（DHI评分≤30）。比较两组患者的年龄、性别、库斯分类、术前前庭功能、治疗组、平衡能力和PA水平，并将这些因素作为自变量，以6个月时的DHI评分为因变量进行线性回归分析。
慢性头晕患者在术后9周时的PA水平显著较低（<0.001），静态和动态平衡能力也较差（分别为=0.023和=0.041）。剔除相关因素后，多元回归分析得出一个包含两个变量（PA水平、TUG）的模型，该模型能显著预测DHI评分（=6.581；=0.239；=0.003）。
本研究揭示了（1）亚急性期PA水平与平衡能力之间以及（2）VS切除术后慢性头晕之间的关联。因此，在亚急性期以非侵入性且不耗时的方式评估PA水平和平衡能力，可能为VS切除术后提供预后信息。
