Clinical case · clinician
Six-week post-operative recovery after vestibular schwannoma resection
Vignette
A 52-year-old man underwent retrosigmoid resection of a 22 mm right-sided vestibular schwannoma 6 weeks ago. He had a preoperative baseline CDP showing mildly reduced C5/C6 (composite 65). He is now seen for postoperative review. He reports good early recovery: he is independent in self-care, walking with a single stick for confidence, but still feels unsteady on uneven ground and in the dark. He has House-Brackmann grade 2 facial weakness and unaidable hearing on the operated side. Postoperative HIT shows a clear corrective saccade to the right.
CDP findings
Single-best-answer
His CDP today shows composite 48, with markedly reduced C5/C6 and falls on C5. How should this be interpreted, and what is the expected trajectory?
Teaching point. Post-resection deafferentation produces acute uncompensated vestibular loss, with a CDP pattern resembling acute neuritis. Central compensation occurs over 3–6 months and can be accelerated by vestibular rehabilitation. Serial CDPs at 6 weeks, 3 months, and 6 months document the trajectory. The preoperative baseline is invaluable for comparison.