Evaluation Quality of Equilibrium after Vestibular Schwannoma Surgery: A Prospective Cohort Study

Objective: To evaluate instability level after vestibular schwannoma surgery and to search for factors predictive of vestibular compensation level. Finally to determine which patient category will be in need of postoperative vestibular rehabilitation. Study Design: Prospective cohort study. Methods: Patients were gathered between 2010 and 2011 in the tertiary referral ENT department Bordeaux. Only patients who were operated upon in case of vestibular schwannoma were included. Audiometric data, VNG, and VEMPs outcome were evaluated on different intervals (day 7 postoperatively, 3 and 6 months). Completed DHI questionnaires were analyzed. Results: Total 48 patients were included in this study. Overall 77% of patients experienced mild instability problems (DHI outcome). Moreover, postoperatively 71% of patients reported a stable or even improved perceived stability. Cystic schwannoma, preoperative normal VEMP, diplopia at postoperative day 7 were all factors predictive of worse equilibrium outcome postoperatively. On the contrary, >75% vestibular deficit on VNG and hearing level class 1 and 2 (Gardner Robertson classification) preoperatively seem to be good prognostic factors concerning equilibrium outcome. Around 56% of patients benefitted of vestibular rehabilitation postoperatively: early start (<1 month) seems to be beneficial for final equilibrium outcome. Conclusion: vestibular schwannoma surgery provides generally good stability results.