The thesis deals with the issues of balance disorders in patients after vestibular schwannoma surgery. The aim of this thesis is to evaluate the effect of targeted rehabilitation with biofeedback on balance disorders and subjective visual vertical compensation. During the period of one year, a group of 20 vestibular schwannoma patients were examined and treated in University Hospital Motol. The compensation of vestbuloocular refex was assessed by a tilt of subjective visual vertical. The level of vestibulospinal compensation was determined according to score of the Activities-Specific Balance Confidence Scale. Patients were examined before the surgery, after the surgery and after the rehabilitation. The Homebalance system, developed by Support center for application outputs and spin-off companies at the 1st Faculty of Medicine, Charles University in Prague, branch office in Kladno, was used for the therapy with visual biofeedback. Another aim of this thesis was to monitor the effect of vestibular prehabituation with ototoxic gentamicin application two months before surgery. The statistical analysis of data proved in the case of subjective visual vertical tilt a significant increase of deviation after surgery and a decrease after rehabilitation. According to the ABC questionnaire the confidence of...

This thesis deals with the evaluation of the vestibulo-ocular reflex in patients indicated for neurosurgical resection of vestibular schwannoma, executed at the Motol University Hospital. To evaluate the function of the vestibulo-ocular reflex, three types of clinical examinations were used. In periods before the surgery, early after the surgery and before leaving the hospital we monitored the patients' ability to perceive subjective visual vertical, which reflects tonic function of otolith organs. Before the surgery we also tested relative dynamic visual acuity during passive isolated head movements in the transversal plane, whose impairment is related to dysfunction of lateral semicircular canals. Furthermore, we obtained patients' preoperative values achieved in caloric reflex test. In the early postoperative period, bordered by the first day after the vestibular schwannoma surgery and the last day of the hospitalization, patients underwent specialized vestibular rehabilitation. Based on statistical analysis of acquired data, we found out that in some patients there was a lesion of the vestibulo-ocular reflex already before the surgery and moreover, there was a correlation between dysfunction of translational and rotational parts of the vestibulo-ocular reflex. Although variance of subjective...

Seules deux structures du système nerveux central adulte, la zone sous-granulaire et la zone sous-ventriculaire, produisent continuellement de nouveaux neurones et sont considérées comme neurogènes. En dehors de ces zones délimitées, le tissu nerveux ne possède pas de telles facultés. Leurs influences anti-neurogènes peuvent cependant être mises entre parenthèses dans certaines conditions. Cela se produit après neurectomie vestibulaire unilatérale (NVU) chez le chat adulte ; en effet, des études immunohistochimiques et comportementales nous ont permis de découvrir l'existence d'une neurogenèse réactionnelle de type GABAergique dans les noyaux vestibulaires désafférentés situés dans le tronc cérébral. Nos résultats témoignent de l'implication fonctionnelle de cette prolifération cellulaire dans la restauration des fonctions posturo-locomotrices suite à une NVU. Nous avons également mis en évidence que les caractéristiques et l'intensité de la désafférentation vestibulaire déterminent, non seulement, le décours temporel de la restauration des fonctions vestibulaires, mais aussi les différents mécanismes cellulaires post-lésionnels et le potentiel neurogène des noyaux vestibulaires. En outre, nous avons démontré que l'activation ou le blocage des récepteurs GABA de type A influence d'une part, les différentes étapes de la neurogenèse réactionnelle dans les noyaux vestibulaires, et détermine d'autre part le décours de la récupération comportementale des animaux. Ainsi, le système GABAergique joue-t-il un rôle important dans la régulation de la neurogenèse induite après NVU et de sa fonctionnalité. / Only two structures of the adult central nervous system: the subgranular zone and the subventricular zone, produce continuously new neurons and are considered as neurogenic. Outside these two delimited areas, nervous tissue does not have such faculties. The anti-neurogenic influences can however be removed under specific conditions. That is what happens after unilateral vestibular neurectomy (UVN) in the adult cat: behavioral and immunohistochemical studies have demonstrated the existence of a reactive GABAergic neurogenesis in the deafferented vestibular nuclei located in the brainstem. Our results demonstrate the functional role of the vestibular cell proliferation in the postural locomotor function recovery after UVN. We also demonstrated that characteristics and intensity of the vestibular lesion, not only determine the time course of recovery of vestibular function, but also the post-lesional cellular mechanisms and the neurogenic potential occurring in the vestibular nuclei. In addition, we showed that activation or blockade of GABA type A receptors influences the different steps of neurogenesis in the vestibular nuclei, and also determines the time course of behavioral recovery. Thus, the GABAergic system influences reactive neurogenesis that is benefic for vestibular compensation process. Finally, the results of a recent study demonstrated that vestibular-hippocampal relations exist, and that stress induced by vestibular deafferentation can modulate adult neurogenesis in both the vestibular nuclei and the dentate gyrus in the adult cat.