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J Neurol Neurosurg Psychiatry 2008;79:1287-1294 doi:10.1136/jnnp.2007.135913
  • Research paper

Visual sensorial preference delays balance control compensation after vestibular schwannoma surgery

  1. C Parietti-Winkler1,
  2. G C Gauchard2,
  3. C Simon3,
  4. Ph P Perrin4
  1. 1
    Inserm ERI 11, Faculty of Medicine, Vandoeuvre-lès-Nancy, and Department of ENT, University Hospital, Nancy, France
  2. 2
    Inserm ERI 11, Faculty of Medicine, Vandoeuvre-lès-Nancy, and Nancy-University, UFR STAPS, Balance Control and Motor Performance, Villers-lès-Nancy, France
  3. 3
    Department of ENT, University Hospital, Nancy, France
  4. 4
    Inserm ERI 11, Faculty of Medicine, Vandoeuvre-lès-Nancy, Nancy-University, UFR STAPS, Balance Control and Motor Performance, Villers-lès-Nancy, and Department of ENT, University Hospital, Nancy, France
  1. Prof Philippe P Perrin, Equilibration et Performance Motrice, Nancy-Université, UFR STAPS, 30, rue du Jardin Botanique, 54 600 Villers-lès-Nancy, France; Philippe.Perrin{at}staps.uhp-nancy.fr
  • Received 26 September 2007
  • Revised 23 April 2008
  • Accepted 23 May 2008
  • Published Online First 1 August 2008

Abstract

Background: Balance control performance after vestibular schwannoma surgical removal follows a course that is characterised by a deterioration in postural performance immediately after unilateral vestibular deafferentation (uVD) and a recovery process (vestibular compensation). However, sensory strategies for balance vary during tumoral growth, which could lead to differences in the preferential use of sensory afferences. This longitudinal study aimed to assess the post-operative sensorimotor strategies of postural regulation according to sensory preference of balance control before surgery.

Methods: Twenty-two patients with vestibular schwannoma (11 relying less on vision (G1), 11 relying more on vision (G2), to control balance before surgery), underwent vestibular, subjective visual vertical (SVV), static posturography and sensory organisation (SOT) tests, before and 8 days, 1 and 3 months after surgery.

Results: In G1 patients, little static posturographic and SOT performance deterioration after uVD was observed, despite vestibular test and SVV modifications. In G2 patients, uVD-related modifications followed a time-course characterised by a degradation in posturographic and SOT, vestibular and SVV performances immediately after uVD and a progressive restoration and even improvement 1 month and particularly 3 months after surgery.

Conclusions: High preference for vision before surgery intervenes in postural degradation immediately after surgery, thus delaying the short-term effects of vestibular compensation on postural control. Long-term performance being similar whatever the visual status before surgery, the time-dependent implementation of the central adaptive mechanisms due to neuroplasticity leads to a modification of neurosensory information hierarchy, allowing reliance on appropriate information, the gain varying according to the postural task to be performed.

Footnotes

  • Competing interests: None declared.

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