Vestibular Prehabilitation-A Single UK Center Experience and Literature Review.

 To assess whether vestibular prehabilitation with intratympanic gentamicin is a useful preoperative adjunct in allowing for early mobilization and short length of stay in patients with vestibular schwannoma (VS).  Retrospective single-center study and literature review.  Tertiary neurosurgical center.  Adult patients undergoing surgery for VS.  Our primary outcome measures were evidence of compensation following prehabilitation (defined as saccades becoming more covert and clustered on video head impulse testing-vHIT), length of stay, and days until mobilization. Secondary outcome measures were reduction in gain on vHIT following treatment as well as need for antiemetics postoperatively.  Ten patients have been treated at our center and the majority have shown preoperative reduction in gain and evidence of compensation on vHIT. Median time to mobilization was 1 day and modal length of stay was 6 days. We found the current evidence to be variable, with small sample sizes and significant variation in outcome measures used.  Overall we have found that the use of vestibular prehabilitation enables early mobilization, shortened length of stay and appears to be a promising preoperative adjunct in this population. Further research and assessment with a multicenter prospective clinical trial is merited.