RSS-Feed abonnieren
DOI: 10.1055/a-2360-9474
Labyrinthectomy Improves Dizziness in Patients with Vestibular Schwannoma
![](https://www.thieme-connect.de/media/jnlsb/EFirst/lookinside/thumbnails/10-1055-a-2360-9474_24apr0079-1.jpg)
Abstract
Objective Dizziness is one of the most prevalent and debilitating symptoms associated with vestibular schwannoma (VS), and there are little data on contributing or alleviating factors in the perioperative setting. In this study, we aimed to evaluate whether vestibular nerve sectioning or labyrinthectomy concomitant with surgical resection would improve dizziness in the postoperative period.
Methods This is a retrospective study of a consecutive series of VS patients who underwent resection at a large tertiary care center between 2009 and 2023. Dizziness at 6 months was the primary endpoint, whereas facial nerve and hearing outcomes were secondary endpoints. Fisher's exact test was used to identify significant differences between categorical variables, and multivariate logistic regression analysis was performed to identify predictors of dizziness as well as facial nerve and hearing outcomes.
Results A total of 333 patients underwent resection of VS at our institution. There was no significant difference in binary reported dizziness based on surgical approach (p = 0.14). However, patients reported significantly less dizziness at discharge (p < 0.01) as well as 6-month (p = 0.02) and 1-year (p < 0.01) follow-up in the translabyrinthine group. On the other hand, patients who underwent labyrinth-sparing approaches reported a significant increase in dizziness that remained up to 1 year from the time of surgery.
Conclusions Our data suggest that labyrinthectomy may improve dizziness symptoms in patients with VS. Selective VN sectioning does not appear to affect dizziness or hearing outcomes. Finally, surgical approach does not affect facial nerve outcomes.
Keywords
vestibular schwannoma - translabyrinthine - labyrinthectomy - vertigo - vestibulopathy - dizzinessPublikationsverlauf
Eingereicht: 24. April 2024
Angenommen: 24. Mai 2024
Accepted Manuscript online:
05. Juli 2024
Artikel online veröffentlicht:
24. Juli 2024
© 2024. Thieme. All rights reserved.
Georg Thieme Verlag KG
Rüdigerstraße 14, 70469 Stuttgart, Germany
-
References
- 1 Carlson ML, Lohse CM, Link MJ. et al. Development and validation of a new disease-specific quality of life instrument for sporadic vestibular schwannoma: the Mayo Clinic Vestibular Schwannoma Quality of Life Index. J Neurosurg 2022; 138 (04) 981-991
- 2 Lloyd SK, Kasbekar AV, Baguley DM, Moffat DA. Audiovestibular factors influencing quality of life in patients with conservatively managed sporadic vestibular schwannoma. Otol Neurotol 2010; 31 (06) 968-976
- 3 Myrseth E, Møller P, Wentzel-Larsen T, Goplen F, Lund-Johansen M. Untreated vestibular schwannoma: vertigo is a powerful predictor for health-related quality of life. Neurosurgery 2006; 59 (01) 67-76
- 4 Brooker JE, Fletcher JM, Dally MJ. et al. Factors associated with symptom-specific psychological and functional impact among acoustic neuroma patients. J Laryngol Otol 2014; 128 (Suppl. 02) S16-S26
- 5 Eisenman DJ, Speers R, Telian SA. Labyrinthectomy versus vestibular neurectomy: long-term physiologic and clinical outcomes. Otol Neurotol 2001; 22 (04) 539-548
- 6 House JW, Brackmann DE. Facial nerve grading system. Otolaryngol Head Neck Surg 1985; 93 (02) 146-147
- 7 Committee on Hearing and Equilibrium guidelines for the evaluation of hearing preservation in acoustic neuroma (vestibular schwannoma). American Academy of Otolaryngology-Head and Neck Surgery Foundation, INC. Otolaryngol Head Neck Surg 1995; 113 (03) 179-180
- 8 Dayal M, Perez-Andujar A, Chuang C, Parsa AT, Barani IJ. Management of vestibular schwannoma: focus on vertigo. CNS Oncol 2013; 2 (01) 99-104
- 9 Ojha S, Clamp PJ. A systematic review of interventions for balance dysfunction in patients with vestibular schwannoma. Otol Neurotol 2020; 41 (03) e295-e303
- 10 Hammerschlag PE, Schuknecht HF. Transcanal labyrinthectomy for intractable vertigo. Arch Otolaryngol 1981; 107 (03) 152-156
- 11 Alarcón AV, Hidalgo LO, Arévalo RJ, Diaz MP. Labyrinthectomy and vestibular neurectomy for intractable vertiginous symptoms. Int Arch Otorhinolaryngol 2017; 21 (02) 184-190
- 12 Godefroy WP, Hastan D, van der Mey AG. Translabyrinthine surgery for disabling vertigo in vestibular schwannoma patients. Clin Otolaryngol 2007; 32 (03) 167-172
- 13 Samii M, Metwali H, Gerganov V. Efficacy of microsurgical tumor removal for treatment of patients with intracanalicular vestibular schwannoma presenting with disabling vestibular symptoms. J Neurosurg 2017; 126 (05) 1514-1519
- 14 Tarnutzer AA, Bockisch CJ, Buffone E, Huber AM, Wettstein VG, Weber KP. Pre-habilitation before vestibular schwannoma surgery-impact of intratympanal gentamicin application on the vestibulo-ocular reflex. Front Neurol 2021; 12: 633356