Transcanal Transvestibular Endoscopic Neurectomy: First Experience

Abstract

Objective: Me ´nie `re's disease is an idiopathic inner ear disorder characterized by recurrent vertigo, fluctuating sensorineural hearing loss, and persistent tinnitus. In 10% to 30% of cases, conservative therapy fails, and Me ´nie `re's disease is defined as intractable. In these patients, ablative techniques with unilateral vestibular deafferentation are mandatory. Several approaches for vestibular neurectomy, which preserve hearing capability, are described. In patients presenting severe dizziness associated with high-grade sensorineural hearing loss, surgical labyrinthectomy, or selected vestibular neurectomy through a translabyrinthine approach are the treatments commonly considered. This study reports the first application of transcanal transvestibular endoscopic neurectomy in two patients with frequent disabling vertigo and high-grade sensorineural hypoacusia. Methods: This was a retrospective chart review including patients with intractable Me ´nie `re's disease who underwent vestibular neurectomy, performed in our ENT department between January 2017 and January 2020, selecting patients with disabling vertigo and high-grade sensorineural hypoacusia. We describe step-by-step the surgical technique of transcanal transvestibular endoscopic neurectomy. Results: Overall, two patients underwent transcanal transvestibular endoscopic neurectomy. We performed transcanal transvestibular neurectomy in all cases. No intraoperative complications were observed. On the 2nd postoperative day, one patient presented CSF leak, leading to surgical revision. A complete resolution of vertigo attacks was observed 6 months after surgery. Conclusion: Even though this study presents a limited number of cases, transcanal transvestibular neurectomy is a promising, safe, and effective procedure in selected cases.

The neurophysiological approach to misophonia: Theory and treatment

“…The situation is further complicated by a push toward determining presumed etiology before establishing a definition. To create a definition of a disorder, it is not necessary to know its etiology, and therefore, the term “idiopathic” is used in many cases (e.g., idiopathic intracranial hypertension, idiopathic ventricular tachycardia, idiopathic sudden sensorineural hearing loss, and Ménière's disease) (Altemose and Buxton, 1999 ; Ciccone et al, 2018 ; Rehder, 2020 ; Desiato et al, 2021 ; Dai et al, 2022 ; de Cates and Winters, 2022 ; Marchioni et al, 2022 ).…”

Recent surgical advances and continued controversies in medically refractory Meniere's disease

“…Recent advances in endoscopic ear and lateral skull base surgery extend to vestibular surgery for Meniere's disease. Minimally invasive trans-canal endoscopic approaches for both labyrinthectomy [52] and VNS [53] offer interesting alternatives to the classic trans-mastoid approach with presumably similar outcomes. And the line between nonablative and ablative surgical blurs with the advent of partially ablative surgery targeting the semicircular canals.…”