Preoperative interventions to improve clinical results in patients with vestibular schwannoma: A systematic review.

In 30 seconds

This systematic review assessed whether preoperative vestibular rehabilitation and/or intratympanic gentamicin (ITG) improve vestibular compensation and functional outcomes after vestibular schwannoma surgery. It included 12 original studies with clinical-trial, cohort, case-control, or case-series designs. A Bayesian random-effects meta-analysis of three studies found a small-to-moderate pooled effect favouring prehabilitation for hospital length of stay (μ = 0.28; 95% CrI -0.37 to 1.00), but uncertainty was wide. Other outcomes could not be pooled because of methodological heterogeneity, and overall risk of bias was moderate-to-high.

Key findings

• Three studies evaluated ITG alone; nine assessed ITG and/or structured vestibular rehabilitation within multimodal prehabilitation.
• For hospital length of stay, the pooled effect favoured prehabilitation (μ = 0.28; 95% CrI -0.37 to 1.00), with moderate heterogeneity and wide uncertainty.
• Posturography and dizziness-handicap outcomes could not be meta-analysed because of methodological heterogeneity.
• Overall risk of bias across the included studies was moderate-to-high.

Why it matters

Vestibular schwannoma surgery can be followed by vestibular and functional challenges, and preoperative preparation may help support recovery. This review suggests a possible benefit for length of stay, while highlighting that evidence for other outcomes remains difficult to compare. The findings underscore the need for standardized outcome measures and stronger trials before the effectiveness of specific prehabilitation approaches can be established.

What to keep in mind

The evidence came from heterogeneous study designs and interventions, with moderate-to-high risk of bias. Only three studies contributed to the length-of-stay meta-analysis, whose estimate had wide uncertainty.