Presurgical Treatment in Vestibular Schwannoma Surgery Enhances Recovery of Postural Control Better than Postoperative Rehabilitation

Objective: To evaluate postsurgical postural stability. Study Design: Retrospective study on consecutive patients. Patients: Total 44 patients with intact vestibular function. Overall 20 were medically deafferented with intratympanic gentamicin before surgery, while performing vestibular rehabilitation exercises before and after the injections (PREHAB). Method: Postural stability measured as energy expenditure while subjected to vibratory stimulation of the calf muscles, measured before surgery (or gentamicin treatment) and 6 months after surgery. Results: Patients pretreated with gentamicin had significantly better postural stability at the time for follow-up (p < 0.05) and displayed a better adaptive capacity when faced with a postural challenge (p < 0.01). They were also able to use vision more efficiently to control their stability (p < 0.05). Conclusions: By separating the sensory loss from the intracranial surgical trauma does the postural control system benefit from a better rehabilitation both in long-term (habituation) and short-term (adaptation) performance, when experiencing a postural challenge or resolving a sensory conflict. The benefits could be attributed to active motor learning as the vestibular function slowly attenuates and completion of sensory reweighting before surgery. In contrast, immobilization from nausea after surgery, stress, and cognitive dysfunction from the combination of surgical and abrupt sensory trauma could explain the worse compensation.