Assessment of visual sensation, psychiatric profile and quality of life following vestibular schwannoma surgery in patients prehabituated by chemical vestibular ablation

Abstract

Aims. Preoperative chemical vestibular ablation can reduce vestibular symptoms in patients who have gone through vestibular schwannoma resection. The goal of this study was to determine whether chemical vestibular prehabituation influences the patients' post-operative perception of visual stimulation, mental status and quality of life. We also tried to find out whether increases of optokinetic nystagmus, measured by routine electronystagmography, correlate with subjective symptoms. Methods. We preoperatively administered (2 months prior to surgery) 0.5-1.0 mL of 40 mg/mL nonbuffered gentamicin in three intratympanic instillations in 11 patients. Head impulse and caloric tests confirmed reduction of vestibular function in all patients. The control group consisted of 21 patients. Quality of life in both groups was evaluated using the Glasgow Benefit Inventory, the Glasgow Health Status Inventory and the Dizziness Handicap Inventory questionnaires. Visual symptoms and optokinetic sensation were evaluated using a specific questionnaire developed by our team and by measuring gains preoperatively and postoperatively in both groups using routine electronystagmography. The psychological profile was evaluated using the Zung Self-Rating Depression Scale and the Generalised Anxiety Disorder Assessment questionnaires. Results. There were no statistically significant differences between both groups with regards to the results of the questionnaires. Patients who received preoperative gentamicin were less sensitive to visual stimulation (P<0.10) and many of them had a significantly higher gain in the optokinetic nystagmus than the control group in the preoperative stage. Conclusion. Pre-treatment with gentamicin helps to lower anxiety levels in patients and improves their general postoperative status. Pre-treated patients are also less sensitive to optokinetic stimulation. Trial Registration: ClinicalTrials.gov, NCT03638310.

Pre-habilitation with intratympanic gentamicin in vestibular schwannomas: a systematic review

“…In certain studies, additional testing was carried out, which included the subjective visual vertical measurement, posturography and the Activities-specific Balance Confidence scale in Hrubá et al ., 11 as well as the subjective visual vertical scale, optokinetic testing and Dizziness Handicap Inventory, General Behaviour Inventory and Glasgow Health Status Inventory in Balatkova et al . 12 and Čada et al . 14 Tjernström et al .…”

“…With respect to patient selection, the studies investigated specific groups; any control groups were appropriately matched. In one of the studies, Balatkova et al ., 12 the selection was not strictly random due to ethical concerns. Patients with serviceable hearing were preferentially assigned to the control group, and those with large tumours that surpassed Koos grade 4 (defined by a large tumour with brainstem and cranial nerve displacement) had the choice to willingly undergo gentamicin treatment because the probability of hearing preservation for them was low.…”

“…The findings and characteristics of the included studies have been summarised (Tables 1-3) to allow for overview and comparison. [9][10][11][12][13][14][15][16] Study origin and tumour-related factors All the included studies originate from European countries; interestingly, there were none from the USA or Asia, areas that traditionally contribute significantly to the literature in this specific field. This distribution of the included studies probably highlights geographic differences in practice.…”

“…The Video Head Impulse Test and/or caloric testing were used to monitor vestibular function in patients. In certain studies, additional testing was carried out, which included the subjective visual vertical measurement, posturography and the Activities-specific Balance Confidence scale in Hrubá et al, 11 as well as the subjective visual vertical scale, optokinetic testing and Dizziness Handicap Inventory, General Behaviour Inventory and Glasgow Health Status Inventory in Balatkova et al 12 and Čada et al 14 Tjernström et al 13,15 and Magnusson et al 10 also used posturography parameters (vibratory perturbation) in addition to the Video Head Impulse Test and caloric testing.…”

Dopo chirurgia del neurinoma vestibolare la funzione vestibolare correla con dati oggettivi estratti dalla risonanza magnetica?

“…The second questionnaire 5 , 6 ( Tab. I ) was developed by neurotologists from the Department of Otorhinolaryngology and Head and Neck Surgery of the 1st Faculty of Medicine, Charles University in Prague, Faculty Hospital Motol.…”