Vestibulární rehabilitace u pacientů po operaci vestibulárního schwannomu

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Authors: M. Bonaventurová ¹; Z. Čada ² ; V. Koucky ¹; V. Bandurová ¹; V. Svobodová ¹; K. Červený ¹; P. Hermann ² ; O. Čakrt ³; Z. Fík ¹; J. Plzák ¹; Z. Balatková ¹
Authors‘ workplace: Department of Otorhinolaryngology and Head and Neck Surgery, 1st Faculty of Medicine Charles University in Prague and University Hospital Motol, Czech Republic ¹; Department of Otorhinolaryngology and Head and Neck Surgery, 2nd Faculty of Medicine Charles University in Prague and University Hospital Motol, Czech Republic ²; Department of Rehabilitation and Sports Medicine, 2nd Medical Faculty, Charles University and University Hospital Motol, Czech Republic ³
Published in: Cesk Slov Neurol N 2023; 86(2): 114-119
Category: Review Article
doi: 10.48095/cccsnn2023114

Overview

Cílem práce je podat přehled o současných možnostech vestibulární rehabilitace u pacientů po operaci vestibulárního schwannomu. Resekce nádoru vede obvykle ke vzniku jednostranné akutní periferní či kombinované vestibulární léze způsobené přerušením větví vestibulárního nervu a případně i poškozením mozečku. Léze se projevuje u pacientů poruchami stability, závratí, oscilopsií a vegetativním doprovodem. Lidský organizmus na tuto situaci reaguje zahájením mechanizmu centrální kompenzace, v níž hraje zásadní úlohu mozeček. Cílem vestibulární rehabilitace je tyto mechanizmy posílit a rekonvalescenci pacientů nejen zrychlit, ale zároveň dosáhnout i lepších funkčních výsledků, neboť ne všichni pacienti jsou schopni lézi dostatečně zkompenzovat. Vestibulární rehabilitace v sobě v současné době zahrnuje kromě specifických vestibulárních cvičení také možnosti využití prehabituace a virtuální reality. Díky prehabituaci, tedy předoperační chemické labyrintektomii pomocí intratympanálně podaného gentamicinu, dochází k časovému oddělení vzniku vestibulární léze od vlastního chirurgického výkonu a tím možnosti dosažení vestibulární kompenzace ještě před samotnou resekcí vestibulárního schwannomu. V poslední dekádě se nástroje pro využití virtuální reality stávají cenově dostupné, a tím pádem i v širší praxi použitelné. Prostřednictvím virtuální reality mohou být pacienti vystavováni scénám, které posilují 3D optokinetickou stimulaci, čímž se rozšiřují možnosti posilování centrálních kompenzačních mechanizmů a tím dochází ke zlepšení kvality života pacientů.

Klíčová slova:

virtuální realita – vestibulární schwannom – vestibulární kompenzace – vestibulární regabilitace – prehabituace

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