Preoperative interventions to improve clinical results in patients with vestibular schwannoma: A systematic review

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.