A Century of Eighth Nerve Surgery

Abstract

The introduction and progressive refinement of eighth nerve section played a central role in the evolution of operative neurotology. Many of the most vigorous debates of recent years (e.g., the choice of operative route, the optimal site of division, and the relative role of inner ear surgery vs. nerve surgery) have antecedents in the controversies of the distant past.

Vestibular compensation following vestibular neurotomy

“…The neurologic phenomenon of vestibular compensation underlies the surgical treatment of Menière's disease (MD) by unilateral vestibular neurotomy (UVN) [1]. Selective vestibular neurotomy causes sudden, total and enduring deafferentation of the vestibular apparatus while sparing the cochlear pathways [2].…”

History of Cerebellopontine Angle Surgery

“…He performed an unsuccessful attempt to remove a tumor, which at autopsy turned out to be VS. One year later, Charles McBurney of New York, after whom the appendectomy incision is named, performed an exploratory posterior fossa craniectomy for a presumed cerebellar tumor [ 28 ] . The fi rst successful complete removal of a CP angle tumor was performed by Sir Charles Balance, a classmate and coworker of Viktor Horsley at the Brown Institute and the National Hospital, Queen Square in London.…”

“…Herbert Olivecrona emphasized the importance of facial nerve preservation. He routinely performed electrical stimulation to identify the nerve and had a special nurse to observe the patient for facial contractions [ 28,55 ] . In 1939 Olivecrona presented his initial results, demonstrating that the facial nerve was preserved in an astonishing for the time rate of 65 % of the patients [ 39 ] .…”

Surgical exposure gained in an extended retrosigmoid approach to the cerebellopontine angle compared to the traditional retrosigmoid approach

“…The conventional retrosigmoid approach to the posterior fossa has been popular and dependable for accessing lesions in the cerebellopontine angle (CPA) and the petroclival region (8,9,11,13,14). This approach is commonly used but requires cerebellar retraction and has limitations for lesions located ventral to the brainstem.…”