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. 2023 Jun;43(3):212-220.
doi: 10.14639/0392-100X-N2367.

Does vestibular function correlate with objective MRI findings after vestibular schwannoma surgery?

Zuzana Balatková  1 , Markéta Bonaventurová  1 , Rudolf Černý  2 , Jiří Lisý  3 , Silvie Brennerová  1 , Vladimír Koucký  1 , Veronika Bandúrová  1 , Veronika Svobodová  1 , Zdeněk Fík  1 , Martin Komarc  4 , Eva Mrázková  5 , Klára Kučerová  6 , Pavel Hermann  7 , Zdeněk Čada  7
Affiliations

Does vestibular function correlate with objective MRI findings after vestibular schwannoma surgery?

Zuzana Balatková et al. Acta Otorhinolaryngol Ital. 2023 Jun.

Abstract
in English, Italian

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.

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.

Keywords: magnetic resonance imaging; unilateral vestibular lesion; vestibular function; vestibular schwannoma; video head impulse test.

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Conflict of interest statement

The authors declare no conflict of interest.

Figures

Figure 1.
Figure 1.
Overview of patient characteristics.
Figure 2.
Figure 2.
MRI scan of the internal auditory canal on the operated side. Facial (empty arrow), cochlear nerve (full arrow), superior vestibular nerve (empty arrowhead), inferior vestibular nerve (full arrowhead), still preserved within internal auditory canal, have blurry contours corresponding with post-operative changes: 3D T2/space.
Figure 3.
Figure 3.
MRI scan of the internal auditory canal on the operated side. Usual configuration of the nerves inside the right-sided internal auditory canal is observed. Of note is the absence of the vestibulocochlear nerve and deformation of the facial nerve (arrow) within the post-operatively changed left-sided internal auditory canal: 3D T2/space.
Figure 4.
Figure 4.
Post-operative vHIT results. Values of VOR gain in the anterior (A), lateral (H) and posterior (P) semicircular canals measured by the vHIT post-operatively on the operated and healthy sides.
Figure 5.
Figure 5.
Change in pure tone average before and after the operation. The study group was divided in three subgroups (1, 2 and 3) according to the value of VOR gain in the horizontal canal measured by the vHIT on the operated side.
Figure 6.
Figure 6.
Response to question 7: Do you have instability with/or does a greater amount of auditory and visual sensations bother you (e.g., shopping malls)? The graph shows the mean value of PTA in each subgroup before and after the operation. The study group was divided in three subgroups (1, 2 and 3) according to the value of VOR gain in the horizontal canal measured by the vHIT on the operated side. The graph shows the mean value for each subgroup before and after the operation.
See this image and copyright information in PMC

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