The Process of Adaptati on of the Balance System after Vestibular Schwannoma Surgery

Authors: P. Vrabec 1;  R. Brzezný 2
Authors‘ workplace: Klinika ORL a chirurgi e hlavy a krku UK 1. LF a FN v Motole, Praha 1;  Oddělení ne urochirurgi e FN v Motole, Praha 2
Published in: Cesk Slov Neurol N 2008; 71/104(4): 453-457
Category: Original Paper

Podporováno grantem IGA, reg. číslo NR/ 8439- 3.


Evalu ati on of the process of adaptati on of the balance system as a result of unilateral vestibular de aferentati on (UVD) after vestibular schwannoma surgery based on analysis of the tilt of the subjective visu al vertical (SVV).

34 pati ents (14 men, 20 women, aged 50.97 ± 13.36 SD) with vestibular schwannoma were examined using the method of me asurement of the SVV tilt before the surgery, 9 to 14 days after the surgery, and 12 to 16 months postoperatively. The results were compared with the respective control gro up. The co urse of the SVV tilt in time was analysed in the pati ents.

The difference between the absolute values of the tilt of SVV in pati ents and healthy controls is statistically significant. The same appli es to the difference between the value of SVV inclinati ons in pati ents in subsequent me asurements (p = 0.005), with e arly post- operative deteri orati on to a medi an of 4° SVV. A significantly higher SVV tilt for the left- sided lesi ons in the first postoperative me asurement was observed (p = 0.02).

Conclusi on:
UVD due to vestibular ne urectomy results in e arly SVV devi ati on towards the operated side, and to subsequent gradu al adaptati on of the system to the level before the surgery, which is still different from the normal values.

Key words:
vestibular schwannoma –  subjective visu al vertical –  unilateral vestibular de aferentati on –  otolith disorder –  vestibular adaptability


1. Sadeghi SG, Minor LB, Cullen KE. Dynamics of the horizontal vestibulo ocular reflex after unilateral labyrinthectomy: response to high frequency, high accelerati on, and high velocity rotati ons. Exp Brain Res 2006; 175(3): 471– 484.

2. Masumura C, Horii A, Mitani K, Kitahara T, Uno A, Kubo T. Unilateral vestibular de afferentati oninduced changes in calci um signalingrelated molecules in the rat vestibular nucle ar complex. Brain Res 2007; 1138: 129– 135.

3. Kitahara T, Horii A, Kizawa K, Maekawa C, Kubo T. Changes in mitochondri al unco upling protein expressi on in the rat vestibular nerve after labyrinthectomy. Ne urosci Res 2007; 59(3): 237– 242.

4. Aleisa M, Zeito uni AG, Cullen KE. Vestibular compensati on after unilateral labyrinthectomy: normal versus cerebellar dysfuncti onal mice. J Otolaryngol 2007; 36(6): 315– 321.

5. Rosenberg SI. Vestibular surgery for Meni ere‘s dise ase in the elderly: a revi ew of techniques and indicati ons. ENT: Ear Nose Thro at J 1999; 78(6): 443– 446.

6. Gacek RR, Gacek MR. Comparison of labyrinthectomy and vestibular ne urectomy in the control of vertigo. Laryngoscope 1996; 106(2): 225– 230.

7. Badke MB, Pyle GM, She a T, Mi edaner J. Outcomes in vestibular ablative procedures. Otol Ne urotol 2002; 23(4): 504– 509.

8. Thomsen J, Berner B, Tos M. Vestibular ne urectomy. Auris Nasus Larynx 2000; 27(4): 297– 301.

9. Goto F, Kobayashi H, Saito A, Hayashi Y, Higashino K, Kunihiro T et al. Compensatory changes in static and dynamic subjective visu al vertical in pati ents following vestibular schwannoma surgery. Auris Nasus Larynx 2003; 30(1): 29– 33.

10. Bohmer A, Mast F, Jarchow T. Can a unilateral loss of otolithic functi on be clinically detected by assessment of the subjective visu al vertical? Brain Res Bull 1996; 40(5– 6): 423– 427.

11. Brzezny R, Vyhnalek M, Cerny R, Jerabek J. Onemocnění otolitových struktur rovnovážného systému. II. Di agnostika. Cesk Slov Ne urol N 2006; 69/ 102(4): 267– 271.

12. Brzezny R, Vyhnalek M, Cerny R, Jerabek J. Onemocnění otolitových struktur rovnovážného systému. I. Patofyzi ologi e a symptomatologi e. Cesk Slov Ne urol N 2006; 69/ 102(4): 259– 266.

13. Gresty MA, Bronstein AM. Testing otolith functi on. Br J Audi ol 1992; 26(2): 125– 136.

14. Fri edmann G. The judgement of the visu al vertical and horizontal with peripheral and central vestibular lesi ons. Brain 1970; 93(2): 313– 328.

15. Curthoys IS, Dai MJ, Halmagyi GM. Human ocular torsi on positi on before and after unilateral vestibular ne urectomy. Exp Brain Res 1991; 85(1): 218– 225

16. Di eterich M, Brandt T. Ocular torsi on and tilt of subjective visu al vertical are sensitive brainstem signs. Ann Ne urol 1993; 33(3): 292– 299.

17. Halmagyi GM. New clinical tests of unilateral vestibular dysfuncti on. J Laryngol Otol 2004; 118(8): 589– 600.

18. Vibert D, Ha usler R. Longterm evo­luti on of subjective visu al vertical after vestibular ne urectomy and labyrinthectomy. Acta Otolaryngol 2000; 120(5): 620– 622.

19. Dai MJ, Curthoys IS, Halmagyi GM. Line ar acceletari on percepti on in the roll plane before and after unilateral vestibular ne urectomy. Exp Brain Res 1989; 77(2): 315– 328.

20. Lopez C, Laco ur M, Ahmadi AE, Magnan J, Borel L. Changes of visu al vertical percepti on: a longterm sign of unilateral and bilateral vestibular loss. Ne uropsychologi a 2007; 45(9): 2025– 2037.

21. Cohen HS, Kimball KT, Jenkin HA. Factors affecting recovery after aco ustic ne uroma resecti on. Acta Otolaryngol 2002; 122(8): 841– 850.

22. Hafstrom A, Fransson PA, Karlberg M, Magnusson M. Idi osyncratic compensati on of the subjective visu al horizontal and vertical in 60 pati ents after unilateral vestibular de afferentati on. Acta Otolaryngol 2004; 124(2): 165– 171.

23. Mehta S, Lotke PA. Impact of surgeon handedness and laterality on o utcomes of total knee arthroplasti es: sho uld right- handed surgeons do only right TKAs? Am J Orthop 2007; 36(10): 530– 533.

24. Driscoll CL, Lynn SG, Harner SG, Be atty CW, Atkinson EJ. Preoperative identificati on of pati ents at risk of developing persistent dysequilibri um after aco ustic ne uroma removal. Am J Otol 1998; 19(4): 491– 495.

Paediatric neurology Neurosurgery Neurology

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