Analyzing Postoperative Vestibulopathy in Vestibular Schwannoma Patients Through Physical Therapy-Based Assessments.

OBJECTIVE

To assess vestibulopathy in vestibular schwannoma (VS) patients who have undergone microsurgical resection and have received vestibular rehabilitation therapy (VRT).

STUDY

DESIGN

Retrospective case series.

SETTING

Tertiary care center.

PATIENTS: Patients reporting persistent dizziness following microsurgical resection of sporadic VS referred to VRT from January 2023 to August 2024 using a recently published clinical practice guideline on vestibular rehabilitation for peripheral vestibular hypofunction.

INTERVENTIONS: VRT.

MAIN OUTCOME MEASURES: Computerized horizontal-dynamic visual acuity (cH-DVA), functional gait assessment (FGA), and dizziness handicap inventory (DHI).

RESULTS

Eighteen patients (11 females, 61%) received VRT with a median age at surgery of 51-years-old [interquartile range (IQR) 41 to 55]. Fifteen patients (83%) had tumors with a cerebellopontine angle component with a median tumor size of 17.7 mm (IQR: 9.9 to 21.2), and 3 patients (17%) had intracanalicular tumors with sizes of 9.3, 12.5, and 13.0 mm. After a median of 5 (IQR: 3 to 10) guided VRT sessions over a median of 7.5 weeks (IQR: 4 to 16), the cH-DVA error for head movements to the operative side was 3.5 lines (IQR: 2.0 to 4.3). The cH-DVA error to the nonoperative side was 2.5 lines (IQR: 1.8 to 3.5) suggesting unanticipated contralateral gaze instability. Following completion of VRT, the median FGA score was 26 (IQR: 22.5 to 27.5), signifying near-normal gait function, and the median DHI was 8 (IQR: 4 to 34), representing minimal handicap.

CONCLUSIONS

Most VS patients with postoperative dizziness and cH-DVA-confirmed functional impairment of the vestibulo-ocular reflex achieved minimal dizziness and near-normal dynamic balance skills after completing VRT. Most patients showed cH-DVA results consistent with bilaterally impaired gaze stabilization.