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Published on: August 30, 2019
Vestibular PREHAB and gentamicin before schwannoma surgery may improve long-term postural function
F Tjernström1, P-A Fransson, B Kahlon
1Department of Otorhinolaryngology, Head and Neck Surgery, Clinical Sciences, ENT Clinic, University Hospital Lund, Lund 22185, Sweden. fredrik.tjernstrom@med.lu.se
Journal of Neurology, Neurosurgery, and Psychiatry
|July 4, 2009
Summary
Pre-surgical gentamicin treatment for unilateral vestibular deafferentation (uVD) improved long-term postural control in patients undergoing vestibular schwannoma surgery. This vestibular training strategy enhances adaptation and reduces symptoms six months post-surgery.
Area of Science:
- Neuroscience
- Vestibular System Research
- Surgical Outcomes
Background:
- Unilateral vestibular deafferentation (uVD) from vestibular schwannoma surgery causes chronic vestibular deficits.
- Compensation for uVD occurs through other sensory inputs.
- Pre-surgical vestibular training (prehabituation) can initiate motor adaptation before surgery.
Purpose of the Study:
- To assess the long-term (6-month) impact of pre-surgical deafferentation on post-surgery postural control.
- To evaluate the efficacy of timed vestibular ablation and sensory training.
Main Methods:
- 41 patients undergoing trans-labyrinthine schwannoma surgery were grouped based on pre-surgery vestibular activity and central lesion signs.
- A subset of patients with remaining vestibular function received gentamicin to induce uVD pre-surgery.
- Vibratory posturography measured postural sway pre-surgery and at 6-month follow-up.
Main Results:
- Patients pretreated with gentamicin showed significantly reduced postural sway at the 6-month follow-up.
- This improvement was noted compared to their own pre-operative recordings.
- The gentamicin group also exhibited better postural control than other study groups.
Conclusions:
- Separating surgical trauma from vestibular deafferentation effects through pre-treatment enhances adaptive processes.
- Efficient adaptation helps resolve sensory conflicts and reduce symptoms.
- This strategy may provide sustained symptom reduction up to six months post-surgery.