Prognosis Analysis Of Vertigo Of Patients With Acoustic Neuroma

Objective: To evaluate the related factors and prognosis of vertigo in patients with acoustic neuroma,and the clinical application of related examinations in patients with acoustic neuroma,so as to provide clinical evidence for the diagnosis and treatment of vertigo in patients with acoustic neuroma.Methods: A total of 126 patients with acoustic neuromas treated by the Department of Neurosurgery,Tianjin Medical University General Hospital from May 2016 to June 2018 were enrolled.After inclusion and exclusion criteria,25 acoustic neuromas were included.Clinical data were collected from 25 patients.Tumor characteristics were described by size(Koos classification)and the presence or absence of cystic transformation.Preoperative examination included head MRI examination,auditory brainstem response,pure tone audiometry,acoustic impedance test,video nystagmography(VNG),and vestibular evoked myogenic potentials(VEMPs).Patients were asked to complete the DHI(Dizziness Handicap Inventory)scale 1 day before surgery to assess subjective vertigo symptoms.VNG,vestibular autorotation test(VAT)and DHI scale were evaluated 3 months after surgery.The patient was reassessed on the DHI scale 6 months after surgery.The outcomes of subjective vertigo symptoms and the factors affecting preoperative and postoperative subjective vertigo symptoms in 25 patients with acoustic neuromas before and 3 months after surgery and 6 months after surgery were analyzed.Statistical analysis was performed using SPSS 23.0 software,and graphed using Origin Pro 8.5.Results:1.According to preoperative hearing results,25 patients with acoustic neuroma were divided into two groups: practical hearing group and non-practical hearing group.Two independent samples T test was used to compare the mean score of DHI scale before operation in the two groups.The patients with no practical hearing were found to have more preoperative vertigo,and the difference was statistically significant(P < 0.001).2.25 patients with acoustic neuroma were examined by VEMPs before operation,Nonparametric test was used to compare the difference of DHI scores between the patients with normaloVEMPs and cVEMPs and the others.It was concluded that preoperative vertigo of patients with normal VEMPs was lighter,and the difference was statistically significant(P=0.015).3.On preoperative VNG,8 patients(32%)had abnormal central signs,T-test were used to compare the average scores of the preoperative DHI scale in the normal group and the abnormal group.Differences may be considered to have an effect on preoperative vertigo,and the difference was statistically significant(P=0.022).Non-parametric tests were used to compare DHI scores of patients with and without spontaneous nystagmus.Spontaneous nystagmus was considered to have an effect on the degree of preoperative vertigo,and the difference was statistically significant(P=0.002).Non-parametric test was used to compare the difference of preoperative DHI scores between patients with abnormal caloric test.It can be considered that the results of caloric test had an effect on preoperative vertigo,and the difference was statistically significant(P=0.026).4.T-test was used to compare the difference of preoperative DHI scores between non-cystic and cystic tumors: cystic transformation was considered to have an negative effect on the degree of preoperative vertigo,and the difference was statistically significant(P=0.012).The effect of tumor size on preoperative DHI score was compared by one-way ANOVA: tumor size was considered to have an effect on preoperative vertigo,and the difference was statistically significant(P=0.024).5.Patients with acoustic neuromas still had high-frequency vestibular loss of function 3 months after surgery,with or without central damage.6.Non-parametric test was used to compare the difference of preoperative and postoperative DHI scores.It can be considered that the preoperative DHI scale score was lower than 6 months after operation(P=0.007).Conclusions:1.Preoperative hearing,VEMPs,VNG examination results and the size and nature of tumors are the influencing factors of preoperative vertigo in patients with acoustic neuroma.Preoperative vertigo in patients without preoperative practical hearing is more serious.Preoperative vertigo in patients with normal preoperative VEMPs is lighter.Preoperative vertigo in patients with abnormal central signs and spontaneous nystagmus issevere.Preoperative UW>80%,preoperative vertigo is lighter.Patients with larger tumors had severe vertigo symptoms.2.High frequency vestibular dysfunction with or without central impairment occurred in patients with acoustic neuroma accompanied by vertigo 3 months after operation.3.In patients with acoustic neuroma,the vertigo situation was significantly worse 3 months after operation than before,and did not recover 6 months after operation.