Abstract
Objective
To assess whether preoperative vestibular rehabilitation and/or intratympanic gentamicin (ITG) improve vestibular compensation and postoperative functional outcomes in patients undergoing vestibular schwannoma surgery.
Design
Systematic review conducted in accordance with the PRISMA 2020 statement.
Study sample
Twelve original studies were identified through PubMed, Web of Science, and Google Scholar. Eligible designs included clinical trials, cohort, case–control, and case-series studies evaluating preoperative vestibular rehabilitation and/or ITG before surgery. Methodological quality was assessed using the Joanna Briggs Institute (JBI) critical appraisal checklists and the RoB 2 tool.
Results
Three studies implemented ITG alone, whereas nine integrated ITG and/or structured vestibular rehabilitation within multimodal prehabilitation protocols. Rehabilitation components ranged from supervised physiotherapy to home-based or hybrid programs. A Bayesian random-effects meta-analysis of three studies evaluating hospital length of stay (LOS) yielded a small-to-moderate pooled effect favouring prehabilitation (μ = 0.28; 95% CrI −0.37 to 1.00), with moderate heterogeneity and wide uncertainty. Other outcomes such as posturography and dizziness handicap could not be meta-analysed due to methodological heterogeneity. Overall risk of bias was moderate-to-high.
Conclusions
Preoperative prehabilitation may support postoperative recovery, particularly when tailored to residual vestibular function and delivered through supervised or hybrid formats. Larger, high-quality randomized trials using standardized outcomes are warranted.
Keywords
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Supplementary Material
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