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.