| 1. |
- Magnusson, Måns, et al.
(författare)
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Preoperative vestibular ablation with gentamicin and vestibular 'prehab' enhance postoperative recovery after surgery for pontine angle tumours - first report
- 2007
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Ingår i: Acta Oto-Laryngologica. - : Informa UK Limited. - 1651-2251 .- 0001-6489. ; 127:12, s. 1236-1240
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Tidskriftsartikel (refereegranskat)abstract
- Conclusions. Preoperative gentamicin in combination with vestibular 'prehab' offers a possibility to reduce postoperative malaise and speed up recovery and may be used for patients undergoing such surgery when there is remaining vestibular function. Objectives. Removal of pontine angle tumours in a patient with remaining vestibular function causes symptoms of acute vestibular loss. A simultaneous cerebellar lesion can cause a combined vestibule-cerebellar lesion. Patients and methods. Twelve patients with pontine angle tumours but with near normal vestibular function were treated with intratympanic gentamicin in combination with vestibular 'prehab' to achieve preoperative vestibular ablation and compensation. After work-up patients started with a home-based vestibular training programme for 14 days. They then received a total of 1.2 ml of 30 mg/ml buffered gentamicin in four intratympanic installations over 2 days. They continued training and returned 6-16 weeks later. All patients were tested with calorics, vestibular video-impulse testing of all six canals, VEMP, subjective visual vertical and horizontal, posturography and pure tone and speech audiometry. Results. There was a loss of caloric reactions and loss of impulses. In two patients the hearing deteriorated and in one hearing improved. All subjects were vestibulary compensated before surgery and no patient complained of dizziness or vertigo after surgery.
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| 2. |
- Magnusson, Måns, et al.
(författare)
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Vestibular "PREHAB"
- 2009
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Ingår i: Annals of the New York Academy of Sciences. - : Wiley. - 0077-8923. ; 1164, s. 257-262
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Tidskriftsartikel (refereegranskat)abstract
- A sudden unilateral loss or impairment of vestibular function causes vertigo, dizziness, and impaired postural function. In most occasions, everyday activities supported or not by vestibular rehabilitation programs will promote a compensation and the symptoms subside. As the compensatory process requires sensory input, matching performed motor activity, both motor learning of exercises and matching to sensory input are required. If there is a simultaneous cerebellar lesion caused by the tumor or the surgery of the posterior cranial fossa, there may be a risk of a combined vestibulocerebellar lesion, with reduced compensatory abilities and with prolonged or sometimes permanent disability. On the other hand, a slow gradual loss of unilateral function occurring as the subject continues well-learned everyday activities may go without any prominent symptoms. A pretreatment plan was therefore implemented before planned vestibular lesions, that is, "PREHAB." This was first done in subjects undergoing gentamicin treatment for morbus Meniere. Subjects would perform vestibular exercises for 14 days before the first gentamicin installation, and then continue doing so until free of symptoms. Most subjects would only experience slight dizziness while losing vestibular function. The approach-which is reported here-was then expanded to patients with pontine-angle tumors requiring surgery, but with remaining vestibular function to ease postoperative symptoms and reduce risk of combined cerebellovestibular lesions. Twelve patients were treated with PREHAB and had gentamicin installations transtympanically. In all cases there was a caloric loss, loss of VOR in head impulse tests, and impaired subjective vertical and horizontal. Spontaneous, positional nystagmus, subjective symptoms, and postural function were normalized before surgery and postoperative recovery was swift. Pretreatment training with vestibular exercises continued during the successive loss of vestibular function during gentamicin treatment, and pre-op gentamicin ablation of vestibular function offers a possibility to reduce malaise and speed up recovery.
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| 3. |
- Tjernström, Fredrik, et al.
(författare)
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Hearing and Vestibular Function After Preoperative Intratympanic Gentamicin Therapy for Vestibular Schwanomma as Part of Vestibular Prehab
- 2016
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Ingår i: Ear and Hearing. - 0196-0202. ; 37:6, s. 744-750
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Tidskriftsartikel (refereegranskat)abstract
- OBJECTIVE:: To evaluate auditory and vestibular function after presurgical treatment with gentamicin in schwannoma patients. BACKGROUND:: The vestibular PREHAB protocol aims at diminishing the remaining vestibular function before vestibular schwannoma surgery, to ensure less acute symptoms from surgery, and initiate a more efficient vestibular rehabilitation already before surgery. However, the potential cochleotoxicity of gentamicin is a concern, since modern schwannoma surgery strives to preserve hearing. STUDY DESIGN:: Retrospective study. SETTING:: University hospital. PATIENTS:: Seventeen patients diagnosed with vestibular schwannoma between 2004 and 2011, and took part in vestibular PREHAB program. The patients were of age 21 to 66 years (mean 48.8), 9 females and 8 males. INTERVENTION:: Intratympanic gentamicin installations before surgery as part of the vestibular PREHAB. MAIN OUTCOME MEASURES:: Hearing thresholds, word recognition score, caloric response, subjective visual vertical and horizontal, cVEMP, and vestibular impulse tests. RESULTS:: Combined analysis of frequency and hearing threshold showed a significant decrease after gentamicin therapy (p <0.001). Pure-tone average decreased with 7.1 ± 8.5 dB (p = 0.004), and speech recognition with 10%. The treatment resulted in unilateral vestibular deafferentation with no notable reaction to bithermal caloric irrigation (reduction 64%, p <0.001), loss of the vestibulo-ocular response measured by the head-impulse test, and deviation of subjective horizontal/vertical to the side of the lesion (+2.2 degrees, p = 0.010). CONCLUSIONS:: Intratympanic installations of gentamicin, as part of the vestibular PREHAB, result in unilateral vestibular deafferentation, but constitute a definite risk for high-frequency hearing loss. The hearing results are in line with those reported upon when treating Menière’s disease.
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| 4. |
- Tjernström, Fredrik, et al.
(författare)
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Vestibular PREHAB and gentamicin before schwannoma surgery may improve long-term postural function
- 2009
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Ingår i: Journal of Neurology, Neurosurgery and Psychiatry. - : BMJ. - 1468-330X .- 0022-3050. ; 80:11, s. 1254-1260
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Tidskriftsartikel (refereegranskat)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.
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