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ObjectiveTo evaluate vestibular compensation via measurement of the vestibulo-ocular reflex (VOR) following vestibular schwannoma surgery and its relationship with changes in saccades strategy after surgery.PatientsThirty-six consecutive patients with vestibular schwannomas, without brainstem compression, underwent surgical resection. Patients were recruited from University Hospital of Salamanca, Spain.MethodsWe assessed the age, sex, tumor size, degree of canalicular weakness, and preoperative video head impulse test (gain and saccade organization measured with PR score). Gain and saccade organization were compared with postoperative values at discharge and also at 1, 3, and 6 months. PR scores are a measure of the scatter of refixation saccades.ResultsPatients with normal preoperative caloric function had higher PR scores (saccades were scattered) following surgery compared to patients with significant preoperative canal paresis (p < 0.05). VOR gain and the presence of covert/overt saccades preoperatively did not influence the PR score (p > 0.05), but a group of patients with very low VOR gain (<0.45) and covert/overt saccades before surgery had lower PR scores after surgery. The differences after 6 months were not significant.ConclusionPatients with more severe vestibular dysfunction before vestibular schwannoma surgery show significantly faster vestibular compensation following surgery, manifested by changes in VOR gain and PR score. The scatter of compensatory saccades (as measured by the PR score) may be a surrogate early marker of clinical recovery, given its relationship to the Dizziness Handicap Inventory.

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NF2 mutations may play a role in the pathophysiology of hearing loss as well as in the pattern of growth of VS. Cigarette smoking in patients with VS seems to play a role in both the risk of developing the tumor and also in its genetic profile. More studies are needed to corroborate these results and, more broadly, to establish links between molecular and clinical data.

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Acute vestibular deficit as the first sign of leukemia is extremely rare. The literature shows some cases of sudden hearing loss accompanied by instability and associated with hyperviscosity syndrome. We present the case of a patient who presents a harmonic vestibular deficit of the right ear. The complementary studies revealed an abnormally high level of leukocytes. A peripheral blood cytogenetic analysis is performed due to a high suspicion of leukemia, and the results show BCR/ABL fusion gene with a cut point in the M-BCR region, which confirms the diagnosis of chronic myeloid leukemia. In this case we detail the importance of taking hematological disorders into consideration in the differential diagnosis of patients with otoneurological symptoms, and we also review the etiopathogenic mechanisms, symptoms, diagnosis, and therapeutic options for chronic myeloid leukemia with sudden hearing loss and vertigo.