This retrospective study was based on data from 44 patients selected from a cohort of 153 who had undergone surgical resection of vestibular schwannoma over a 10-year period. The aim was to evaluate the dynamics of the postural control system and the benefit of a gradual sensory attenuation from preoperative intratympanic gentamicin. All patients had residual vestibular function quantified with a battery of objective vestibular function tests. Group 1 consisted of 24 patients who had no preoperative intratympanic gentamicin (no PREHAB). Group 2 consisted of 20 patients who had PREHAB. Both groups were given unsupervised vestibular exercises two weeks before and for at least six weeks after surgery. In the PREHAB group, the exercises started two weeks before intratympanic gentamicin. There were no significant differences in age, tumour size, surgical approach and residual vestibular function between the two groups. Postural control using a Force Platform was assessed preoperatively and at six months postoperatively in all subjects, in quiet stance and during four perturbation periods. In quiet stance, stability was better in the gentamicin group enhanced further by vision.

In perturbed stance, postural stability was better in the gentamicin group who also benefitted more from the effect of vision, compared to the non-treated group. The gentamicin group coped better during perturbations and spent less energy maintaining their posture.

The authors argued that this better postural control was centrally-mediated. PREHAB ensured that acute vestibular symptoms associated with acute deafferentation from surgery, such as vertigo, nausea and oscillopsia that would interfere with recovery, were reduced. The authors could have used more validated outcome measures to strengthen their findings. In my view, I think PREHAB deserves broad acceptance. 

PREHAB vs. REHAB – presurgical treatment in vestibular schwannoma surgery enhances recovery of postural control better than postoperative rehabilitation: retrospective case series.
Tjernström F, Fransson P-A, Kahlon B, et al.
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Victor Osei-Lah

Bournemouth, UK.

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