Vestibular prehabillitation – a single UK centre experience and literature review

Objectives To assess whether vestibular prehab with intratympanic gentamicin is a useful preoperative adjunct in allowing for early mobilisation and short length of stay in patients with vestibular schwannoma Design Retrospective single centre study and literature review Setting Tertiary neurosurgical centre Participants Adult patients undergoing surgery for vestibular schwannoma Main Outcome Measures Our primary outcome measures were evidence of compensation following prehab (defined as saccades becoming more covert and clustered on video Head Impulse Testing – vHIT), length of stay and days until mobilisation. Secondary outcome measures were reduction in gain on vHIT testing following treatment as well as need for anti-emetics post-operatively. Results Ten patients have been treated at our centre and the majority have shown pre-operative reduction in gain and evidence of compensation on video head impulse testing (VHIT). Median time to mobilisation was 1 day and modal length of stay was 6 days. We found the current evidence to be variable, with small sample sizes and significant variation in outcome measures used. Conclusions Overall we have found that the use of vestibular prehab enables early mobilisation, shortened length of stay and appears to be a promising pre-operative adjunct in this population. Further research and assessment with a multi-centre prospective clinical trial is merited.