Posterior fossa vestibular neurotomy as primary surgical treatment of Menière’s disease: a re-evaluation

Pareschi, Roberto; Destito, D.; Raucci, A. Falco; Righini, Stefano; Colombo, Sarah

doi:10.1258/00222150260171560

Cited by 19 publications

(5 citation statements)

References 16 publications

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“…The efficacy rate (efficacy class A) found in our study (90.5%) is very high and is comparable to the data in the literature. 1,[8][9][10][11][12][13][14][15][16][17][18][19][20][21] This result confirms that the complete sectioning of the vestibular nerve ensures total and permanent vestibular deafferentation. It also reflects the results of the postoperative vestibular explorations performed as demonstrated in a previous study.…”

Section: Discussionsupporting

confidence: 73%

“…Cases of meningitis are also exceptional-in all studies they accounted for less than 1%. 10,20 The rate of total deafness in the literature is extremely low (0%-9%), and seems proportionally lower in cases of retrosigmoid approach (0%-1.7%) 1,15,[17][18][19] than in cases of retrolabyrinthine approach (0%-2.14%) 13,18,33 or the middle fossa approach (0%-9%). [8][9][10][11][12]14 No total deafness and no permanent facial paralysis were observed in our study; the frequency of the latter complication appears to be lower in the case of the posterior fossa approach (0.04% for peripheral facial paralysis, of which 100% were regressive) than of the middle fossa (7% for peripheral facial paralysis, of which 3.75% were permanent).…”

Section: Discussionmentioning

confidence: 99%

“…This instability remains much less disabling than the initial symptoms (10% discomfort among patients considered unstable after surgery). 13,16,17,29,30 Therefore, it should not be an obstacle to the surgical indication of VN.…”

Section: Discussionmentioning

confidence: 99%

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Long-term efficacy of vestibular neurotomy in disabling Ménière’s disease and Tumarkin drop attacks

Véleine¹,

Brenet²,

Labrousse³

et al. 2022

Journal of Neurosurgery

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OBJECTIVE When Ménière’s disease (MD) becomes disabling due to the frequency of attacks or the appearance of drop attacks (i.e., Tumarkin otolithic crisis) despite "conservative" medical and surgical treatments, a radical treatment like vestibular neurotomy (VN) is possible. An ideal MD treatment would relieve symptoms immediately and persist after the therapy. The aim of this study was to identify if VN was effective after 10 years of follow-up regarding vertigo and drop attacks, and to collect the immediate complications. METHODS The authors report a retrospective, single-center (i.e., in a single tertiary referral center with otoneurological surgery activity) cohort study conducted from January 2003 to April 2020. All patients with unilateral disabling MD who had received a VN with at least 10 years of follow-up were included. The therapeutic efficacy was defined by complete disappearance of vertigo and drop attacks. The postoperative complications (CSF leak, total deafness, meningitis, death) were determined immediately after the surgery, and the hearing thresholds were determined during the patient follow-up with the pure tone average (PTA). RESULTS A total of 74 patients (of 85 who were eligible), average age 51.9 ± 11.1 years, including 38 men (51.4%), with disabling MD and/or Tumarkin drop attacks (24.3%) received VN, with at least 10 years of follow-up after surgery. After an average follow-up of 12.4 ± 1.7 years (range 10.0–16.3 years), 67 patients (90.5%) no longer presented any vertiginous attacks, and no patient experienced drop attack. The mean variation in early pre- and postoperative PTA was not statistically significant (n = 64, 2.2 ± 10.3 decibels hearing level [range −18 to 29], 95% CI [−0.4 to 4.37]; p = 0.096), and 84.4% of the patients evaluated had unchanged or improved postoperative PTA. Three significant complications were noted, including two surgical revisions for CSF leak. There was no permanent facial paralysis, meningitis, or death. CONCLUSIONS In case of disabling MD (disabling vertigo refractory to conservative vestibular treatments—Tumarkin drop attacks), VN via the retrosigmoid approach must be the prioritized proposal in comparison to intratympanic gentamicin injections, because of the extremely low complication rate and the immediate and long-lasting effect of this treatment on vertigo and falls.

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Section: Discussionsupporting

confidence: 73%

Section: Discussionmentioning

confidence: 99%

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Long-term efficacy of vestibular neurotomy in disabling Ménière’s disease and Tumarkin drop attacks

Véleine¹,

Brenet²,

Labrousse³

et al. 2022

Journal of Neurosurgery

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“…Simultaneously, the intratympanic administration of gentamicin therapy has increased to become the most frequently used invasive treatment for Ménière's disease (Silverstein et al 2003). However, one of the main advantages of the neurectomy is that it preserved the hearing of more than 98% of patients (Silverstein et al 1989;Pareschi et al 2002;Schlegel et al 2012), whereas labyrinthectomy systematically sacrifices hearing (Diaz et al 2017). Unfortunately, current clinical imaging technics do not allow for checking the presence of newborn neurons in deafferented vestibular nuclei in response to curative vestibular neurectomy.…”

Section: Clinical Relevancementioning

confidence: 99%

Adult neurogenesis promotes balance recovery after vestibular loss

Tighilet

Chabbert

2019

Progress in Neurobiology

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A phenomenon called vestibular compensation occurs after peripheral vestibular loss. This process involves a mosaic of profound structural rearrangements within the vestibular nuclei.Among them, adult reactive neurogenesis is perhaps the most unexpected, as it occurs in a brain area that was never reported as neurogenic before. Both the survival and functionality of this newly generated neuronal network depend on its integration into preexisting networks in the deafferented structure. Far from being aberrant, this organization allows the brain to use inputs from other sensory modalities to facilitate the restoration of posture and equilibrium. This is the best example so far of the reparative role of adult neurogenesis. Recent findings show that a similar phenomenon exists in other brain sensory structures, such as auditory brain stem nuclei and sensory motor cortex. This raises questions about the putative functional relevance of the reactive neurogenesis.

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“…To the best of our knowledge, there are no published studies that report on CI after vestibular neurectomy for MD. Nowadays, retrosigmoid vestibular neurectomy is less frequently performed as an alternative for refractory vertigo, even though the success rate is very high (89-96%) (35,36). Hearing preservation (within 10 dB of the pre-operative level) can be achieved in the majority of patients (36,37).…”

Section: Vestibular Neurectomy and CImentioning

confidence: 99%

Quality of Life Following Cochlear Implantation in Patients With Menière's Disease

et al. 2021

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Background: Menière's disease (MD) is a disorder characterized by auditory and vestibular dysfunction that significantly deteriorates patients' quality of life (QoL). In addition to the management of vestibular symptoms, some patients with bilateral hearing loss meet criteria for cochlear implantation (CI).Objectives: (1) To assess hearing results and QoL outcomes following CI in patients with MD. (2) To compare these results to a matched control group of patients who had undergone CI. (3) To analyse differences in MD patients who have undergone simultaneous or sequential labyrinthectomy or previous neurectomy.Methods: A retrospective analysis of a study group of 18 implanted patients with MD and a matched control group of 18 implanted patients without MD, who had CI at a tertiary referral center. Hearing and speech understanding were assessed via pure-tone audiometry (PTA) and disyllabic perception tests in quiet. QoL was assessed via the Nijmegen Cochlear Implant Questionnaire (NCIQ), the Glasgow Benefit Inventory (GBI), the Speech, Spatial and Qualities of Hearing Scale (SSQ12), and the Hearing Implant Sound Quality Index (HISQUI19). The impact of MD ablative surgeries was analyzed in the study group (MD group).Results: Mean pre-operative PTA thresholds were significantly lower in the MD group (103 vs. 121 dB). A significant improvement in hearing outcomes was observed following CI in both groups (p < 0.001), with a maximum Speech Discrimination Score of 64 and 65% disyllables at 65 dB for the MD and control group, respectively. Subjective outcomes, as measured by the NCIQ, GBI, SSQ12, and HISQUI19 did not significantly differ between groups. In the MD group, despite achieving similar hearing results, QoL outcomes were worse in patients who underwent simultaneous CI and labyrinthectomy compared to the rest of the MD group. Post-operative NCIQ results were significantly better in patients who had undergone a previous retrosigmoid neurectomy when compared to those who had undergone only CI surgery in the subdomains “basic sound perception” (p = 0.038), “speech” (p = 0.005), “activity” (p = 0.038), and “social interactions” (p = 0.038).Conclusion: Patients with MD and severe hearing loss obtain hearing results and QoL benefits similar to other CI candidates. Delayed CI after labyrinthectomy or vestibular neurectomy can be performed with similar or better results, respectively, to those of other cochlear implanted patients. Patients who undergo simultaneous CI and labyrinthectomy may achieve similar hearing results but careful pre-operative counseling is needed.

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Posterior fossa vestibular neurotomy as primary surgical treatment of Menière’s disease: a re-evaluation

Cited by 19 publications

References 16 publications

Long-term efficacy of vestibular neurotomy in disabling Ménière’s disease and Tumarkin drop attacks

Long-term efficacy of vestibular neurotomy in disabling Ménière’s disease and Tumarkin drop attacks

Adult neurogenesis promotes balance recovery after vestibular loss

Quality of Life Following Cochlear Implantation in Patients With Menière's Disease

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