Combined Retrosigmoid Retrolabyrinthine Vestibular Nerve Section: Results of our Experience over 10 Years

Göksu, Nebil; Yılmaz, Metin; Bayramoğlu, İsmet; Bayazıt, Yıldırım A.

doi:10.1097/01.mao.0000169778.54162.7d

Cited by 12 publications

(5 citation statements)

References 15 publications

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“…322 Retrospective cohort studies have demonstrated vertigo control rates that range from 78% to .90%. [330][331][332][333][334] Complications from this procedure include hearing loss, facial nerve injury, postoperative headache, and risks of craniotomy, such as bleeding, meningitis, and CSF leak. 317,322 Residual vestibular function resulting in persistent symptoms may result due to incomplete VNS, as there is not a well-defined separation between the vestibular and cochlear nerve.…”

Section: Supporting Textmentioning

confidence: 99%

“…VNS is not specifically classified as an inner ear ablative procedure; rather, it is an intradural procedure that involves selective transection of the vestibular nerve while preserving the cochlear nerve 322 . Retrospective cohort studies have demonstrated vertigo control rates that range from 78% to >90% 330–334 . Complications from this procedure include hearing loss, facial nerve injury, postoperative headache, and risks of craniotomy, such as bleeding, meningitis, and CSF leak 317 , 322 .…”

Section: Guideline Key Action Statementsmentioning

confidence: 99%

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Clinical Practice Guideline: Ménière’s Disease

Basura

Adams

Monfared

et al. 2020

Otolaryngol.--head neck surg.

219

207

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Objective Ménière’s disease (MD) is a clinical condition defined by spontaneous vertigo attacks (each lasting 20 minutes to 12 hours) with documented low- to midfrequency sensorineural hearing loss in the affected ear before, during, or after one of the episodes of vertigo. It also presents with fluctuating aural symptoms (hearing loss, tinnitus, or ear fullness) in the affected ear. The underlying etiology of MD is not completely clear, yet it has been associated with inner ear fluid (endolymph) volume increases, culminating in episodic ear symptoms (vertigo, fluctuating hearing loss, tinnitus, and aural fullness). Physical examination findings are often unremarkable, and audiometric testing may or may not show low- to midfrequency sensorineural hearing loss. Conventional imaging, if performed, is also typically normal. The goals of MD treatment are to prevent or reduce vertigo severity and frequency; relieve or prevent hearing loss, tinnitus, and aural fullness; and improve quality of life. Treatment approaches to MD are many and typically include modifications of lifestyle factors (eg, diet) and medical, surgical, or a combination of therapies. Purpose The primary purpose of this clinical practice guideline is to improve the quality of the diagnostic workup and treatment outcomes of MD. To achieve this purpose, the goals of this guideline are to use the best available published scientific and/or clinical evidence to enhance diagnostic accuracy and appropriate therapeutic interventions (medical and surgical) while reducing unindicated diagnostic testing and/or imaging.

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Section: Supporting Textmentioning

confidence: 99%

Section: Guideline Key Action Statementsmentioning

confidence: 99%

Clinical Practice Guideline: Ménière’s Disease

Basura

Adams

Monfared

et al. 2020

Otolaryngol.--head neck surg.

219

207

View full text Add to dashboard Cite

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“…Total labyrinthectomy is performed in patients with poor hearing and has reported success rates of approximately 95%. [1][2][3] In MD, these procedures provide a stabilized vestibular system by eliminating fluctuating vestibular signals. However, these 2 operations cause unilateral inner ear dysfunctions in patients, therefore having negative effects on the vestibulo-ocular reflex (VOR) and global balance.…”

Section: Introductionmentioning

confidence: 99%

The Relationship of Vestibulo-Ocular Reflex With Self-Reported Dizziness Handicap in Patients With Vestibular Deafferentation

et al. 2019

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The relationship between objective vestibular tests and subjective vestibular tests is a controversial topic. In this study, to contribute to this issue, the vestibulo-ocular reflex features and their relationship with balance perception at long-term follow-up in vestibular neurectomy (VN) and total labyrentectomy patients were evaluated. Prospectively, 19 VN and 18 labyrinthectomy patients were enrolled in this study. Patients underwent video head impulse test (VHIT) as objective vestibular test and dizziness handicap inventory (DHI) as subjective vestibular test when they attended to their control visit follow-up between March and September 2017. Lateral canal corrective saccades were classified as organized pattern and deorganized (scattered) pattern. In our results, the saccade pattern analysis (between organized and deorganized saccades) regarding the DHI scores gave P value as .039 for covert saccade pattern and .050 for overt saccade pattern. Therefore, we conclude that the presence of saccades, their patterns, and amplitudes provide extra information at assessing the results of the VHIT test, and the organized pattern of saccades is related to a stable vestibular system and better balance perception.

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“…Vestibular input to the CNS is normally bilateral and symmetrical. 12,25,34 Symptoms of vertigo typically develop when vestibular disease on 1 side causes this input to become asymmetrical. The rationale for ablating the peripheral vestibular system, therefore, is to completely eliminate the abnormal vestibular input from the diseased side.…”

Section: Discussionmentioning

confidence: 99%

“…This should allow for near complete resolution of a patient's vestibular symptoms in Ménière disease. 12,34 In the 1930s, McKenzie and Dandy 16 introduced the concept of sectioning only the vestibular portion of cranial nerve VIII via a suboccipital craniectomy to treat symptoms of intractable vertigo in patients with medically refractory Ménière disease. In 1961, House 13 described the middle cranial fossa approach to the IAC for vestibular nerve sectioning.…”

Section: Discussionmentioning

confidence: 99%

Two-handed endoscopic-directed vestibular nerve sectioning: case series and review of the literature

Cutler

Kaloostian

Ishiyama

et al. 2012

JNS

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ObjectVestibular nerve sectioning is an accepted surgical treatment option for patients with medically refractory Ménière disease. In this paper the authors introduce and evaluate a 2-handed endoscopic-directed technique for vestibular nerve section.MethodsEleven patients underwent a retrosigmoid craniectomy for endoscopic-directed vestibular nerve sectioning as treatment for intractable vertigo associated with Ménière disease. In all patients, identification and dissection of the cranial nerve VII/VIII complex was performed entirely under endoscopic guidance. The authors used the specially designed Frazee II neuroendoscope, consisting of a traditional endoscope lens with a microsuction attachment.ResultsVestibular nerve sectioning was completed in all 11 patients. Postoperative improvement in vertiginous episodes was achieved in 10 patients (91%). Auditory function was noted to be worse postoperatively in only 1 patient (9%). The same patient also developed a House-Brackmann Grade III facial nerve palsy, which improved gradually over time. There were no further complications, including no delayed CSF leaks.ConclusionsThe endoscopic-directed approach represents a safe and effective method for performing vestibular nerve sectioning. Until now, the endoscope has been used primarily as an adjunct to the operating microscope in surgery at the cerebellopontine angle. In addition, previous endoscopic techniques typically require a third hand to manipulate the endoscope. With the 2-handed endoscopic-directed technique, however, the endoscope is used as the primary means of visualization, and the unique design of this endoscope allows for a bimanual procedure without the requirement of a cosurgeon. Advantages of using this technique compared with the microscope include superior brightness at close distances, greater depth of field, increased maneuverability within small regions, and an improved ability to visualize objects not in a direct line of sight. Among other things, this allows for minimally invasive openings, decreased cerebellar retraction, and better identification of nerve cleavage planes and vascular anatomy.

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Combined Retrosigmoid Retrolabyrinthine Vestibular Nerve Section: Results of our Experience over 10 Years

Abstract: VN performed using retrosigmoid-retrolabyrinthine approach has low complication and high vertigo control and hearing preservation rates. It can be applied as an initial surgery or reserved as the last step when the other surgical treatments have failed to control vertigo.

Cited by 12 publications

References 15 publications

Clinical Practice Guideline: Ménière’s Disease

Clinical Practice Guideline: Ménière’s Disease

The Relationship of Vestibulo-Ocular Reflex With Self-Reported Dizziness Handicap in Patients With Vestibular Deafferentation

Two-handed endoscopic-directed vestibular nerve sectioning: case series and review of the literature

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