Balance Problems:
Central Vestibular Neuropathy

Most post-op balance problems are caused by the destruction of the vestibular apparatus, performed as a part of the translab surgery, or by accidental servering of the vestibular nerve as a result of other surgical approaches.  The resulting problems are usually temporary, and can be overcome with the help of vestibular rehabilitation or exercises.

However, sometimes patients experience central vestibular neuropathy. This means that the problem is due to surgical damage to the central nervous system (cerebellum, brainstem), which is responsible for processing signals from the vestibular nerves and for controlling or coordination our muscles.  This damage, sometimes referred to as trauma, can be temporary or permanent.

One such problem is ataxia, defined as "inability to coordinate muscular movements".  In the British Medical Journal (October 28 1995) in "Management of Acoustic Neuroma" on p. 311, there is the following explanation of ataxia's causes:

retraction of the cerebellum, to gain access to the cerebellopontine angle, may occasionally cause severe and persistent ataxia

Another such problem is known as titubation.  This is defined as "a constant nodding tremor of the head" (when trying to hold one's head up straight), and sometimes as "a stumbling gait" (a staggering or unsteadiness when standing or walking). But in either case, there is agreement that this is a problem with controlling our muscles, caused by damage (temporary or permanent) to the cerebellum.

(quotes are by AN patients, italics added)

Central vestibular neuropathy has a profound and permanent effect on one's ability to control motion:

My cerebellum was disturbed during surgery which resulted in my not being able to balance myself, which resulted in my not being able to stand, walk or even sit without toppling over. Physical therapy got me walking again, not perfectly, though. I still have a balance problem. Can't run, skip, jump, etc... Can't wear any shoe with a heel. But I CAN walk!!!! Kind of walk like a drunken sailor, always veering toward the left. But compared to the day after surgery when I virtually couldn't do anything, I'm grateful for what I got back. BTW, my surgery was May, '95.

[Editor:  walking like a "drunken sailor" is known as ataxic gait]

My first surgery was 10-91 and my second was 2-94. My cerebellum and brain stem were disturbed 1st time. I had physical therapy for one year, they never let me out of pool, balance was to far off. To this day I can't get on knees or wear heels without losing balance. I run only in my dreams.

Due to central vestibular neuropathy, I have not compensated for my balance after 4 years despite I have been in Vestibular Rehab for 2 years.

Though the above quote from BMJ is about the suboccipital approach, the translabyrinthine approach can also cause central vestibular neuropathy:

[It's been] over two years since my TransLab...  I have ataxia. What it means for me it that I cannot use my right hand to work a mouse well and I used to. I can't do any task that requires accuracy like typing or running an adding machine (I used to do both by touch). I had to re-learn how to walk that took 6 months... The silver lining I'm left handed so I didn't have to relearn how to write or eat.

A discussion of the various surgical approaches, and on the retraction of the cerebellum, can be found here.

Last Edited: Wednesday, October 30, 2002