Jan Maurer1, Torsten Frommeld, Wolf Mann. 1. Department of Otorhinolaryngology, University of Mainz Medical School, Germany. maurer@hno.klinik.uni-mainz.de
Abstract
BACKGROUND: Vestibular compensation after acoustic neuroma surgery is affected by many parameters. Apart from surgical approach, age of the patient, and comorbidity, the use of rehabilitative vestibular training and the degree of preoperative vestibular compensation play their respective roles. OBJECTIVE: To examine whether and how surgical preservation of one branch of the vestibular nerve affects the compensation process in patients after acoustic neuroma removal. STUDY DESIGN: Prospective study involving 29 patients with acoustic neuromas. In 15 patients operated on by the middle fossa or retrosigmoid approach, one branch of the vestibular nerve could be preserved intraoperatively, and the course of the compensation process was followed (Group 1). Fourteen other patients with acoustic neuroma, who were operated on via a translabyrinthine approach, served as a control group (Group 2). MAIN OUTCOME MEASURE: The evaluation of vestibular compensation was accomplished clinically, by electronystagmography, and by dynamic posturography. RESULTS: An accelerated vestibular compensation was found in all examinations for Group 1, and 3 months after surgery 47% of the patients in this group were back to work without substantial restrictions, compared with 29% of Group 2. At the end of 6 months, however, there was no more significant difference between the two groups. CONCLUSION: The long-term results of vestibular compensation do not seem to be influenced by partial preservation of the vestibular nerve, whereas the compensation process seems to be accelerated when the nerve is partially preserved.
BACKGROUND: Vestibular compensation after acoustic neuroma surgery is affected by many parameters. Apart from surgical approach, age of the patient, and comorbidity, the use of rehabilitative vestibular training and the degree of preoperative vestibular compensation play their respective roles. OBJECTIVE: To examine whether and how surgical preservation of one branch of the vestibular nerve affects the compensation process in patients after acoustic neuroma removal. STUDY DESIGN: Prospective study involving 29 patients with acoustic neuromas. In 15 patients operated on by the middle fossa or retrosigmoid approach, one branch of the vestibular nerve could be preserved intraoperatively, and the course of the compensation process was followed (Group 1). Fourteen other patients with acoustic neuroma, who were operated on via a translabyrinthine approach, served as a control group (Group 2). MAIN OUTCOME MEASURE: The evaluation of vestibular compensation was accomplished clinically, by electronystagmography, and by dynamic posturography. RESULTS: An accelerated vestibular compensation was found in all examinations for Group 1, and 3 months after surgery 47% of the patients in this group were back to work without substantial restrictions, compared with 29% of Group 2. At the end of 6 months, however, there was no more significant difference between the two groups. CONCLUSION: The long-term results of vestibular compensation do not seem to be influenced by partial preservation of the vestibular nerve, whereas the compensation process seems to be accelerated when the nerve is partially preserved.