Vertigo Perception and Quality of Life in Patients after Surgical Treatment of Vestibular Schwannoma with Pretreatment Prehabituation by Chemical Vestibular Ablation

Abstract

Surgical removal of vestibular schwannoma causes acute vestibular symptoms, including postoperative vertigo and oscillopsia due to nystagmus. In general, the dominant symptom postoperatively is vertigo. Preoperative chemical vestibular ablation can reduce vestibular symptoms postoperatively. We used 1.0 mL of 40 mg/mL nonbuffered gentamicin in three intratympanic installations over 2 days, 2 months preoperatively in 10 patients. Reduction of vestibular function was measured by the head impulse test and the caloric test. Reduction of vestibular function was found in all gentamicin patient groups. After gentamicin vestibular ablation, patients underwent home vestibular exercising for two months. The control group consisted of 10 patients who underwent only home vestibular training two months preoperatively. Postoperative rates of recovery and vertigo in both groups were evaluated with the Glasgow Benefit Inventory (GBI), the Glasgow Health Status Inventory (GHSI), and the Dizziness Handicap Inventory questionnaires, as well as survey of visual symptoms by specific questionnaire developed by us. There were no statistically significant differences between both groups with regard to the results of questionnaires. Patients who received preoperative gentamicin were more resilient to optokinetic and optic flow stimulation (p < 0.05). This trial is registered with clinical study registration number NCT02963896.

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

“…In time 3, patients in the gentamicin group showed positive scores, whereas we observed negative scores in the control group, that indicates deterioration of the health status. These results agree with previous findings 9 , with the exception of the DHI score. Gentamicin pretreated patients recorded a better DHI score in time 2 and 3, which was, however, not statistically significant (P=0.164 and P=0.191).…”

“…After the surgery, there is only minor deterioration in the pre-treatment group. In the long-term follow-up, these differences in score remained stable in this study, but the findings are not statistically significant 9 .…”

“…Vestibular compensation is a complicated process, which includes adaptation to sudden labyrinth failure and leads to substitution of missing vestibular information by other senses, changes in the postural strategy, and behavioural adaptations 9,20 . The preoperative degree of failure of labyrinth function, as well as psychological, social and other factors are studied as factors influencing the final level of handicap after sudden vestibular loss, including vestibular neurectomy 3,21,22 .…”

“…The same questionnaires we used in our previous study were used for this study 9 . The GBI questionnaire contains 18 questions.…”

“…This procedure preoperatively decreases labyrinth function and allows for faster compensation in the postoperative period 8 . Sensitivity to visual stimulus and optic flow is one of the symptoms described in the literature 8,9 , which occurs after an acute peripheral vestibular lesion. In the Čada study (2016), the gentamicin-treated patient group was significantly less sensitive to optic flow stimulation than the control group, respective to the "supermarket syndrome".…”