Abstract
The aim of this study is to consider predictive factors influencing central vestibular compensation in patients who underwent surgery for vestibular schwannoma. Surgical removal of vestibular schwannoma causes acute peripheral vestibular loss due to surgical lesion to both branches of vestibular nerve and in some cases lesion of cerebellum.
The postoperative symptoms are postural instability, vertigo, oscillopsia sometimes accompanied with vegetative symptoms. Factors affecting compensation may be divided into several groups.
Firstly, general health status of a patient as well as the tumour itself affects the compensation, then actual state of function of vestibular system plays important role. Finally, compensation may be induced by therapist.
Central compensation, in which cerebellum plays dominant role, influences duration of the symptoms. Therapeutic aim is to induce compensatory mechanisms as soon as possible and to reduce overall duration of the compensation.
Early operated vestibular rehabilitation is currently the basic procedure. It leads to faster recovery in majority of patients.
However, in some patients it is difficult to achieve full compensation despite maximum effort of physiotherapist and that results in permanent functional deficit manifesting with postural instability. Chemical prehabituation with gentamicin is one of the options how to achieve this goal.
Ototoxic antibiotic is installed intratympanically which causes reduction of vestibular function and helps to start compensatory mechanisms already in preoperative period. Reduction of duration of the whole compensatory process and reduction of intensity of vertigo should be achieved.