Vestibular PREHAB and gentamicin before schwannoma surgery may improve long-term postural function.
BACKGROUND
Unilateral vestibular deafferentation (uVD), as performed in vestibular schwannoma surgery, results in a chronic vestibular deficit, though most of the insufficiency can be compensated by other sensory input. By vestibular training (prehabituation) performed before surgery, motor adaptation processes can be instigated before the actual lesion. The adaptation processes of the altered sensory input could be affected if the vestibular ablation and surgery were separated in time, by pretreating patients who have remaining vestibular function with gentamicin.


OBJECTIVE
To determine whether presurgical deafferentation would affect postsurgery postural control also in a long-term perspective (6 months).


METHODS
41 patients subjected to trans-labyrinthine schwannoma surgery were divided into four groups depending on the vestibular activity before surgery (with no clinical significant remaining function n = 17; with remaining function n = 8), whether signs of central lesions were present (n = 10), and if patients with remaining vestibular activity were treated with gentamicin with the aim to produce uVD before surgery (n = 6). The vibratory posturography recordings before surgery and at the follow-up 6 months after surgery were compared.


RESULTS
The subjects pretreated with gentamicin had significantly less postural sway at the follow-up, both compared with the preoperative recordings and compared with the other groups.


CONCLUSIONS
The results indicate that by both careful sensory training and separating the surgical trauma and the effects of uVD in time, adaptive processes can develop more efficiently to resolve sensory conflicts, resulting in a reduction of symptoms not only directly after surgery but also perhaps up to 6 months afterwards.
Tjernström
F
F
Department of Otorhinolaryngology, Head and Neck Surgery, Clinical Sciences, ENT Clinic, University Hospital Lund, Lund 22185, Sweden. fredrik.tjernstrom@med.lu.se
Fransson
P-A
PA
Kahlon
B
B
Karlberg
M
M
Lindberg
S
S
Siesjö
P
P
Magnusson
M
M
D000222:Adaptation, Physiological; D000328:Adult; D000368:Aged; D003714:Denervation; D005260:Female; D005839:Gentamicins / Q000494:pharmacology*; D006185:Habituation, Psychophysiologic; D006801:Humans; D008297:Male; D008875:Middle Aged; D009464:Neuroma, Acoustic / Q000150:complications / Q000601:surgery / Q000628:therapy*; D009475:Neurons, Afferent; D004856:Postural Balance / Q000187:drug effects*; D011300:Preoperative Care / Q000379:methods*; D012678:Sensation Disorders / Q000188:drug therapy*; D013997:Time Factors
D005839:Gentamicins