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Vestibular PREHAB and gentamicin before schwannoma surgery may improve long-term postural function

Tjernström, Fredrik LU ; Fransson, Per-Anders LU ; Kahlon, Babar LU ; Karlberg, Mikael LU ; Lindberg, Sven LU ; Siesjö, Peter LU and Magnusson, Måns LU (2009) In Journal of Neurology, Neurosurgery and Psychiatry 80(11). p.1254-1260
Abstract
Background: Unilateral vestibular deafferentation (uVD), as performed in vestibular schwannoma surgery, results in a chronic vestibular deficit, though most of the insufficiency can be compensated by other sensory input. By vestibular training (prehabituation) performed before surgery, motor adaptation processes can be instigated before the actual lesion. The adaptation processes of the altered sensory input could be affected if the vestibular ablation and surgery were separated in time, by pretreating patients who have remaining vestibular function with gentamicin. Objective: To determine whether presurgical deaf-ferentation would affect postsurgery postural control also in a long-term perspective (6 months). Method: 41 patients subjected... (More)
Background: Unilateral vestibular deafferentation (uVD), as performed in vestibular schwannoma surgery, results in a chronic vestibular deficit, though most of the insufficiency can be compensated by other sensory input. By vestibular training (prehabituation) performed before surgery, motor adaptation processes can be instigated before the actual lesion. The adaptation processes of the altered sensory input could be affected if the vestibular ablation and surgery were separated in time, by pretreating patients who have remaining vestibular function with gentamicin. Objective: To determine whether presurgical deaf-ferentation would affect postsurgery postural control also in a long-term perspective (6 months). Method: 41 patients subjected to trans-labyrinthine schwannoma surgery were divided into four groups depending on the vestibular activity before surgery (with no clinical significant remaining function n = 17; with remaining function n = 8), whether signs of central lesions were present (n = 10), and if patients with remaining vestibular activity were treated with gentamicin with the aim to produce uVD before surgery (n = 6). The vibratory posturography recordings before surgery and at the follow-up 6 months after surgery were compared. Results: The subjects pretreated with gentamicin had significantly less postural sway at the follow-up, both compared with the preoperative recordings and compared with the other groups. Conclusion: The results indicate that by both careful sensory training and separating the surgical trauma and the effects of uVD in time, adaptive processes can develop more efficiently to resolve sensory conflicts, resulting in a reduction of symptoms not only directly after surgery but also perhaps up to 6 months afterwards. (Less)
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author
organization
publishing date
type
Contribution to journal
publication status
published
subject
in
Journal of Neurology, Neurosurgery and Psychiatry
volume
80
issue
11
pages
1254 - 1260
publisher
BMJ Publishing Group
external identifiers
  • wos:000271261400208
  • scopus:72249103839
ISSN
1468-330X
DOI
10.1136/jnnp.2008.170878
language
English
LU publication?
yes
id
053d6402-ad48-47d9-91b5-83236e3b5b34 (old id 1517673)
date added to LUP
2010-01-04 15:34:58
date last changed
2017-10-01 04:08:40
@article{053d6402-ad48-47d9-91b5-83236e3b5b34,
  abstract     = {Background: Unilateral vestibular deafferentation (uVD), as performed in vestibular schwannoma surgery, results in a chronic vestibular deficit, though most of the insufficiency can be compensated by other sensory input. By vestibular training (prehabituation) performed before surgery, motor adaptation processes can be instigated before the actual lesion. The adaptation processes of the altered sensory input could be affected if the vestibular ablation and surgery were separated in time, by pretreating patients who have remaining vestibular function with gentamicin. Objective: To determine whether presurgical deaf-ferentation would affect postsurgery postural control also in a long-term perspective (6 months). Method: 41 patients subjected to trans-labyrinthine schwannoma surgery were divided into four groups depending on the vestibular activity before surgery (with no clinical significant remaining function n = 17; with remaining function n = 8), whether signs of central lesions were present (n = 10), and if patients with remaining vestibular activity were treated with gentamicin with the aim to produce uVD before surgery (n = 6). The vibratory posturography recordings before surgery and at the follow-up 6 months after surgery were compared. Results: The subjects pretreated with gentamicin had significantly less postural sway at the follow-up, both compared with the preoperative recordings and compared with the other groups. Conclusion: The results indicate that by both careful sensory training and separating the surgical trauma and the effects of uVD in time, adaptive processes can develop more efficiently to resolve sensory conflicts, resulting in a reduction of symptoms not only directly after surgery but also perhaps up to 6 months afterwards.},
  author       = {Tjernström, Fredrik and Fransson, Per-Anders and Kahlon, Babar and Karlberg, Mikael and Lindberg, Sven and Siesjö, Peter and Magnusson, Måns},
  issn         = {1468-330X},
  language     = {eng},
  number       = {11},
  pages        = {1254--1260},
  publisher    = {BMJ Publishing Group},
  series       = {Journal of Neurology, Neurosurgery and Psychiatry},
  title        = {Vestibular PREHAB and gentamicin before schwannoma surgery may improve long-term postural function},
  url          = {http://dx.doi.org/10.1136/jnnp.2008.170878},
  volume       = {80},
  year         = {2009},
}