Effect of vestibular preoperative rehabilitation on balance control following vestibular schwannoma surgery: Preliminary study

Abstract

Vestibular schwannoma (VS) is a benign tumour from Schwann cells surrounding the vestibular nerve, which slowly grows within the internal auditory canal and then into the cerebellopontine angle. Its development and the total unilateral vestibular deafferentation induced by the surgical tumor removal decrease the postural performance. However, it was demonstrated that the preoperative practice of physical activity and other factors significantly reduced the worsening of postural performance after surgical surgery. Therefore, we hypothesized that a preoperative vestibular rehabilitation will increase the postoperative postural performance of VS patients in comparison with those who benefited from usual clinical management. After randomisation, 10 VS patients were included in two groups: 4 in intervention group (IG) who benefited from 10 physiotherapy sessions between 45 and 3 days before the surgery; 6 in control group (CG) who did not benefited from preoperative rehabilitation. The patients’ balance control was assessed by a sensory organization test (SOT, Equitest, Neurocom, USA). The postural performance was measured by a composite equilibrium score (CES), which varies between 0 to 100% (0% = falls; 100% = perfect stability) and reflects the patient's ability to make effective use of visual, vestibular, and somatosensory inputs separately and to suppress sensory information that is inappropriate. They realized 6 visits: 45 and 3 days before the surgery; and 8, 30 and 90 days after the surgery. The two groups presented similar CES values 45 and 3 days before surgery (CG: 63 ± 14% and 63 ± 10%; IG: 59 ± 13% and 70 ± 8%, respectively). Eight days after the surgery, IG patients increased their CES comparatively to CG (57 ± 16% vs. 42 ± 16%, respectively). The results became similar 30 days after the surgery (CG: 69 ± 10%; IG: 67 ± 9%) as well as after 90 days (CG: 68 ± 14%; IG: 73 ± 6%). The preoperative vestibular rehabilitation seems to diminish the deleterious effect of vestibular deafferentation on balance control early after the surgery. The physiotherapy might induce a gradual implementation of central adaptive mechanisms, called postural compensation before the unilateral vestibular deafferentation. The confirmation of this preliminary result can open a new perspective to support the patients with a vestibular schwannoma.