{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,3,9]],"date-time":"2026-03-09T22:06:10Z","timestamp":1773093970686,"version":"3.50.1"},"reference-count":45,"publisher":"Frontiers Media SA","license":[{"start":{"date-parts":[[2021,2,9]],"date-time":"2021-02-09T00:00:00Z","timestamp":1612828800000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":["frontiersin.org"],"crossmark-restriction":true},"short-container-title":["Front. Neurol."],"abstract":"<jats:p><jats:bold>Background:<\/jats:bold> Patients with vestibular schwannoma that show residual peripheral-vestibular function before surgery may experience sudden and substantial vestibular loss of function after surgical resection. To alleviate the sudden loss of peripheral-vestibular function after vestibular-schwannoma (VS) resection, pre-surgical intratympanic gentamicin application was proposed.<\/jats:p><jats:p><jats:bold>Objective:<\/jats:bold> We hypothesized that this approach allows for a controlled reduction of peripheral-vestibular function before surgery but that resulting peripheral-vestibular deficits may be canal-specific with anterior-canal sparing as observed previously in systemic gentamicin application.<\/jats:p><jats:p><jats:bold>Methods:<\/jats:bold> Thirty-four patients (age-range = 27\u201370 y) with unilateral VS (size = 2\u201350 mm) were included in this retrospective single-center trial. The angular vestibulo-ocular reflex (aVOR) was quantified before and after (29.7 \u00b1 18.7 d, mean \u00b1 1SD) a single or two sequential intratympanic gentamicin applications by use of video-head-impulse testing. Both aVOR gains, cumulative saccadic amplitudes, and overall aVOR function were retrieved. Statistical analysis was done using a generalized linear model.<\/jats:p><jats:p><jats:bold>Results:<\/jats:bold> At baseline, loss of function of the horizontal (20\/34) and posterior (21\/34) canal was significantly (<jats:italic>p<\/jats:italic> &amp;lt; 0.001) more frequent than that of the anterior canal (5\/34). After gentamicin application, loss of function of the horizontal (32\/34) or posterior (31\/34) canal remained significantly (<jats:italic>p<\/jats:italic> \u2264 0.003) more frequent than that of the anterior canal (18\/34). For all ipsilesional canals, significant aVOR-gain reductions and cumulative-saccadic-amplitude increases were noted after gentamicin. For the horizontal canal, loss of function was significantly larger (increase in cumulative-saccadic-amplitude: 1.6 \u00b1 2.0 vs. 0.8 \u00b1 1.2, <jats:italic>p<\/jats:italic> = 0.007) or showed a trend to larger changes (decrease in aVOR-gain: 0.24 \u00b1 0.22 vs. 0.13 \u00b1 0.29, <jats:italic>p<\/jats:italic> = 0.069) than for the anterior canal.<\/jats:p><jats:p><jats:bold>Conclusions:<\/jats:bold> Intratympanic gentamicin application resulted in a substantial reduction in peripheral-vestibular function in all three ipsilesional canals. Relative sparing of anterior-canal function noted at baseline was preserved after gentamicin treatment. Thus, pre-surgical intratympanic gentamicin is a suitable preparatory procedure for reducing the drop in peripheral-vestibular function after VS-resection. The reasons for relative sparing of the anterior canal remain unclear.<\/jats:p>","DOI":"10.3389\/fneur.2021.633356","type":"journal-article","created":{"date-parts":[[2021,2,9]],"date-time":"2021-02-09T06:08:14Z","timestamp":1612850894000},"update-policy":"https:\/\/doi.org\/10.3389\/crossmark-policy","source":"Crossref","is-referenced-by-count":11,"title":["Pre-habilitation Before Vestibular Schwannoma Surgery\u2014Impact of Intratympanal Gentamicin Application on the Vestibulo-Ocular Reflex"],"prefix":"10.3389","volume":"12","author":[{"given":"Alexander A.","family":"Tarnutzer","sequence":"first","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Christopher J.","family":"Bockisch","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Elena","family":"Buffone","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Alexander M.","family":"Huber","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Vincent G.","family":"Wettstein","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Konrad P.","family":"Weber","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"1965","published-online":{"date-parts":[[2021,2,9]]},"reference":[{"key":"B1","doi-asserted-by":"publisher","first-page":"e001345","DOI":"10.1136\/bmjopen-2012-001345","article-title":"What intervention is best practice for vestibular schwannomas? 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