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Bruns' Nystagmus in Patients With Vestibular Schwannoma

Lloyd, Simon K. W.; Baguley, David M.; Butler, Katy; Donnelly, Neil; Moffat, David A.

doi: 10.1097/MAO.0b013e3181a32bec
Tumors of The Ear and Cranial Base

Objectives: To determine the prevalence of Bruns' nystagmus in patients undergoing surgical treatment for unilateral sporadic vestibular schwannomas (VSs), identify the clinical characteristics of patients with Bruns' nystagmus and compare these characteristics with those of VS patients with no nystagmus and other types of nystagmus, and determine the long-term impact of having preoperative Bruns' nystagmus.

Study Design: A retrospective review using a prospectively updated database of patients who had undergone surgical removal of a VS. Patients were divided into 3 groups: Bruns' nystagmus, other types of nystagmus, or no nystagmus. Statistical comparison of each group was undertaken.

Patients: Nine hundred eighty-four patients were included consisting of 492 men and 492 women with a mean age of 59 years (range, 11-86 yr).

Results: Bruns' nystagmus was present in 11% of patients. Bruns' nystagmus was associated with larger tumor size (p < 0.001). Beyond 3.5-cm maximum diameter, 92% of patients had nystagmus, 67% of which had Bruns' nystagmus. Preoperative balance impairment was present in 95% of patients with Bruns' nystagmus compared with 59% with no nystagmus. The balance status of all groups improved considerably postoperatively, but the patients with Bruns' nystagmus had a relatively greater improvement in balance status.

Conclusion: Bruns' nystagmus occurs in patients with large VSs. These patients tend to have greater balance impairment pre\operatively, but after surgery, long-term balance outcomes are similar to those of patients with no nystagmus or other forms of nystagmus.

Department of Otolaryngology, Clinic 10, Cambridge University Hospitals NHS Trust, Addenbrooke's Hospital, Cambridge, U.K.

Address correspondence and reprint requests to Simon K. W. Lloyd, M.B.B.S., B.Sc. (Hons), F.R.C.S. (ORL-HNS), 20a Merton Rise, London NW3 3EN, U.K.; E-mail:

© 2009 Otology & Neurotology, Inc.