title: Prognostic Factors of Balance Quality After Transpetrosal Vestibular Schwannoma Microsurgery: An Instrumentally and DHI-based Prospective Cohort Study of 48 Patients.
abstract: OBJECTIVE
  To evaluate short- and mid-term level of imbalance after vestibular schwannoma (VS) microsurgery by the transpetrosal approach, to search for factors predictive of vestibular compensation, and to determine which patient categories need a postoperative vestibular rehabilitation program.
  
  
  METHODS
  Prospective cohort study at a tertiary referral center.
  
  
  METHODS
  Between 2010 and 2011, patients aged 18 to 75 operated on for VS by transpetrosal approaches were included. VS was characterized by its size (Koos classification) and the presence or not of a cystic component. Hearing was classified according to the Gardner Robertson grading. The preoperative workup included an audiogram, computerized video nystagmography (VNG) with caloric testing, gaze study, rotatory tests, click-evoked cervical vestibular evoked myogenic potential measurements (cVEMPs), and subjective visual vertical test. Patients were asked to complete a Dizziness Handicap Inventory (DHI). Postoperatively, patients were reevaluated on D7 (clinical status), D90 (VNG and DHI), and D180 (DHI). Timing and duration of vestibular rehabilitation were also recorded.
  
  
  RESULTS
  Forty-eight patients were included. Preoperatively, 77% experienced mild instability problems with a mean DHI score of 14.1 (range 4-32). Postoperatively, 71% reported stable or even improved perceived stability. Mean DHI scores were 28.1 on D90 and 19.8 on D180. Serviceable hearing, cystic transformation, normal cVEMPs, diplopia, and vestibular syndrome on D7 were found to be predictive of worse equilibrium outcome than when absent. A preoperative caloric deficit greater than 75% seemed to be a good prognostic factor. Vestibular rehabilitation was conducted in 56% of patients. Starting it early (<1 mo) seemed to be beneficial for final equilibrium outcome.
  
  
  CONCLUSIONS
  VS microsurgery provides good stability results. Some preoperative parameters may be predictive of worse or improved balance recovery, as is clinical status on D7.
authors: *Departments of Otolaryngology and Skull Base Surgery and †Neurosurgery, Pellegrin University Hospital, Bordeaux Segalen University, Bordeaux, France.
authors: Hans
authors: H
authors: Thomeer
authors: Damien
authors: D
authors: Bonnard
authors: Valérie
authors: V
authors: Franco-Vidal
authors: Florence
authors: F
authors: Porez
authors: Patricia
authors: P
authors: Darrouzet
authors: Dominique
authors: D
authors: Liguoro
authors: Vincent
authors: V
authors: Darrouzet
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D015331:Cohort Studies; D004244:Dizziness / Q000453:epidemiology / Q000209:etiology / Q000534:rehabilitation; D005260:Female; D006801:Humans; D008297:Male; D008866:Microsurgery / Q000009:adverse effects / Q000379:methods; D008875:Middle Aged; D009464:Neuroma, Acoustic / Q000601:surgery*; D019635:Neurosurgical Procedures / Q000009:adverse effects* / Q000379:methods; D011184:Postoperative Period; D004856:Postural Balance / Q000502:physiology*; D011379:Prognosis; D011446:Prospective Studies; D012678:Sensation Disorders / Q000453:epidemiology / Q000209:etiology* / Q000534:rehabilitation; D014717:Vertigo / Q000453:epidemiology / Q000209:etiology / Q000534:rehabilitation / Q000601:surgery; D014724:Vestibular Function Tests; D014722:Vestibule, Labyrinth / Q000601:surgery; D055815:Young Adult