OBJECTIVE: Resection of the vestibular schwannoma causes acute peripheral vestibular loss. The process of central compensation starts immediately afterward. The rehabilitation goal is to support this process and restore the quality of life. MATERIALS AND METHODS: In this prospective single-center study, 67 consecutive patients underwent vestibular schwannoma resection (40 females, mean age 52 ± 12 years). The patients were divided into three groups: the prehabilitation with intratympanic gentamicin group, the virtual reality group (optokinetic stimulation via virtual reality goggles in the first ten days after the surgery), and the control group. All patients were examined with objective methods and completed questionnaires before the prehabilitation, before the surgery, at the hospital discharge, and after three months. RESULTS: Intratympanic gentamicin prehabilitation leads ipsilaterally to a significant aVOR reduction in all semicircular canals (p < 0.050), the increase of the unilateral weakness in air calorics (p = 0.026), and loss of cVEMPs responses (p = 0.017). Prehabilitation and postoperative exposure to virtual reality scenes improved the patient's perception of vertigo problems according to Dizziness Handicap Inventory (p = 0.039 and p = 0.076, respectively). These findings conform with the optokinetic testing results, which showed higher slow phase velocities at higher speeds (40 deg/s) in both targeted groups compared to the control group. CONCLUSION: Preoperative intratympanic gentamicin positively affects peripheral vestibular function, influencing balance perception after VS resection. In long-term follow-up, prehabilitation and postoperative exposure to virtual reality improve patients' quality of life in the field of vertigo problems.

• Klíčová slova
• Intratympanic gentamicin, Optokinetic tests, Prehabilitation, Vestibular schwannoma, Video head impulse test, Virtual reality,
• MeSH
• antibakteriální látky * aplikace a dávkování   MeSH
• dospělí MeSH
• gentamiciny * aplikace a dávkování   MeSH
• intratympanická injekce MeSH
• kvalita života MeSH
• lidé středního věku MeSH
• lidé MeSH
• předoperační péče * metody   MeSH
• prospektivní studie MeSH
• senioři MeSH
• terapie pomocí virtuální reality * metody   MeSH
• vestibulární schwannom * chirurgie   rehabilitace   MeSH
• virtuální realita * MeSH
• výsledek terapie MeSH
• Check Tag
• dospělí MeSH
• lidé středního věku MeSH
• lidé MeSH
• mužské pohlaví MeSH
• senioři MeSH
• ženské pohlaví MeSH
• Publikační typ
• časopisecké články MeSH
• srovnávací studie MeSH
• Názvy látek
• antibakteriální látky * MeSH
• gentamiciny * MeSH

OBJECTIVE: Vestibular schwannoma surgery leads to acute unilateral vestibular loss. In some patients, however, the process of post-operatively initiated central compensation proceeds more rapidly than in others. This study aimed to evaluate post-operative vestibular function and correlate it with morphological findings of MRI scans. METHODS: The study included 29 patients who underwent surgery for vestibular schwannoma. Vestibular function was analysed post-operatively by video head impulse test (vHIT). Subjective symptoms were evaluated using validated questionnaires. All patients underwent MRI 3 months post-operatively, and the presence of the facial and vestibulocochlear nerves in the internal auditory canal was assessed. RESULTS: The vestibulo-ocular reflex gain measured by the vHIT correlated positively with audiological findings. Subjective perception of vestibular disorder did not correlate with objectively measured vestibular impairment or with MRI findings. CONCLUSIONS: After the resection of vestibular schwannoma, some patients may still have preserved vestibular function as measured by vHIT. The preserved function does not correlate with subjective symptoms. Patients with partially deteriorated vestibular function showed lower sensitivity to combined stimuli.

UNLABELLED: Dopo chirurgia del neurinoma vestibolare la funzione vestibolare correla con dati oggettivi estratti dalla risonanza magnetica? OBIETTIVO: La chirurgia dello schwannoma vestibolare causa un deficit vestibolare unilaterale acuto. Tuttavia, in alcuni pazienti il processo di compenso centrale post-operatorio progredisce più rapidamente rispetto ad altri. Il presente studio è finalizzato a valutare la funzione vestibolare post-operatoria e correlarla con i dati morfologici della risonanza magnetica. METODI: Lo studio analizza 29 pazienti sottoposti a chirurgia per schwannoma vestibolare. La funzione vestibolare è stata analizzata nel post-operatorio con il “video head impulse test” (vHIT). I sintomi soggettivi sono stati indagati mediante questionari validati. Tutti i pazienti sono stati sottoposti a risonanza magnetica 3 mesi dopo l’intervento, e su questo esame è stata determinata la presenza dei nervi facciale e vestibolo-cocleare nel canale uditivo interno. RISULTATI: Il riflesso vestibolo-oculare misurato con il vHIT correla positivamente con i dati audiologici. La percezione soggettiva dei sintomi vestibolari non correla né con i dati oggettivi di deficit vestibolare né con le immagini della risonanza magnetica. CONCLUSIONI: Dopo la resezione di uno schwannoma vestibolare i pazienti possono ancora preservare la funzione vestibolare, come è stato misurato con il vHIT. L’entità della funzione preservata non correla con i sintomi soggettivi. I pazienti con una funzione vestibolare parzialmente deteriorata mostrano una minor sensibilità agli stimoli combinati.

• Klíčová slova
• magnetic resonance imaging, unilateral vestibular lesion, vestibular function, vestibular schwannoma, video head impulse test,
• MeSH
• lidé MeSH
• pulsní rotační test MeSH
• vestibulární aparát * MeSH
• vestibulární nemoci * MeSH
• vestibulární schwannom * MeSH
• vestibulookulární reflex fyziologie   MeSH
• Check Tag
• lidé MeSH
• Publikační typ
• časopisecké články MeSH

Decision making on the treatment of vestibular schwannoma (VS) is mainly based on the symptoms, tumor size, patient's preference, and experience of the medical team. Here we provide objective tools to support the decision process by answering two questions: can a single checkup predict the need of active treatment?, and which attributes of VS development are important in decision making on active treatment? Using a machine-learning analysis of medical records of 93 patients, the objectives were addressed using two classification tasks: a time-independent case-based reasoning (CBR), where each medical record was treated as independent, and a personalized dynamic analysis (PDA), during which we analyzed the individual development of each patient's state in time. Using the CBR method we found that Koos classification of tumor size, speech reception threshold, and pure tone audiometry, collectively predict the need for active treatment with approximately 90% accuracy; in the PDA task, only the increase of Koos classification and VS size were sufficient. Our results indicate that VS treatment may be reliably predicted using only a small set of basic parameters, even without the knowledge of individual development, which may help to simplify VS treatment strategies, reduce the number of examinations, and increase cause effectiveness.

• MeSH
• dospělí MeSH
• klinické rozhodování * MeSH
• lidé středního věku MeSH
• lidé MeSH
• management nemoci * MeSH
• reprodukovatelnost výsledků MeSH
• řízené strojové učení MeSH
• ROC křivka MeSH
• rozhodovací stromy MeSH
• senioři MeSH
• sluch MeSH
• sluchové testy MeSH
• strojové učení * MeSH
• určení symptomu MeSH
• vestibulární schwannom diagnóza   terapie   MeSH
• Check Tag
• dospělí MeSH
• lidé středního věku MeSH
• lidé MeSH
• mužské pohlaví MeSH
• senioři MeSH
• ženské pohlaví MeSH
• Publikační typ
• časopisecké články MeSH
• práce podpořená grantem MeSH

PURPOSE: Vestibular schwannoma removal causes unilateral vestibular deafferentation, which results in dizziness and postural unsteadiness. Vertigo and balance problems together are among the most important aspects affecting quality of life. Intensive vestibular rehabilitation, which starts before surgery, with following postsurgical supervised rehabilitation, using visual biofeedback propose an instrument to accelerate a recovery process. Another option how to accelerate the vestibular compensation, is employment of presurgical gentamicin ablation together with vestibular rehabilitation (prehabilitation) of vestibular function. Purpose of present study was to examine the dynamics of vestibular compensation process using supervised intensive vestibular rehabilitation with visual biofeedback in the short-term postsurgical period. The second aim was to compare both studied groups mainly to evaluate if prehabilitation has potential to accelerate the compensation process in the early postoperative course. METHODS: The study included 52 patients who underwent the retrosigmoid vestibular schwannoma removal. They were divided into two groups. The first group was prehabilitated with intratympanic application of gentamicin before surgery to cause unilateral vestibular loss (14 patients), the second group (38 patients) was treated in standard protocol without prehabilitation. All patients underwent at home vestibular training before surgery to learn new movement patterns. Following the surgery supervised intensive vestibular rehabilitation including visual biofeedback was employed daily in both groups between the 5th and 14th postoperative day. Outcome measurements included an evaluation of subjective visual vertical (SVV), posturography and the Activities-Specific Balance Confidence Scale (ABC). ANOVA for repeated measurements was used for statistical analysis. RESULTS: We observed significant improvement in SVV (p < 0.05), posturography parameters (p < 0.05) and ABC scores (p < 0.05) with postoperative rehabilitation program following surgery in both groups. There was no statistically significant difference between group treated by prehabilitation and group without prehabilitation. CONCLUSIONS: Results of this study showed that intensive postsurgical rehabilitation represents key factor in compensation process following retrosigmoid vestibular schwannoma surgery. Prehabilitation did not speed up recovery process.

• Klíčová slova
• Compensation, Posturography, Prehabilitation, Rehabilitation, Subjective visual vertical, Vestibular schwannoma,
• MeSH
• kvalita života * MeSH
• lidé středního věku MeSH
• lidé MeSH
• neurorehabilitace metody   MeSH
• otologické chirurgické výkony škodlivé účinky   metody   rehabilitace   MeSH
• pooperační komplikace * psychologie   rehabilitace   MeSH
• premedikace metody   MeSH
• vertigo * etiologie   rehabilitace   MeSH
• vestibulární schwannom chirurgie   MeSH
• výsledek terapie MeSH
• závrať * etiologie   rehabilitace   MeSH
• Check Tag
• lidé středního věku MeSH
• lidé MeSH
• mužské pohlaví MeSH
• ženské pohlaví MeSH
• Publikační typ
• časopisecké články MeSH