Vestibular neurectomy

Abstract

A brief history of the vestibular neurectomy is given. This treatment modality was introduced in Denmark by us, using the experiences obtained by the use of translabyrinthine treatment modality for vestibular schwannoma surgery. This paper presents our experiences with this type of surgery (translabyrinthine, retrolabyrinthine and retrosigmoid vestibular nerve section) from 1980 to 1996, including 43 operations in 42 patients. The patients had all been treated with conventional methods without success and were all severely handicapped by their attacks of vertigo. The mean age was 51 years, postoperative observation time between 2 and 15 years, with a mean of 6.4 years. The vertigo was controlled in 88% of the patients, while postoperative imbalance occurred in 14 patients, mainly due to the ablation of the vestibular labyrinth and not by episodic vertigo. A total of 39 patients indicated that they were satisfied with the operation. Six patients were deaf before surgery and 92% of the remaining patients retained their preoperative hearing. Postoperative complications were few, including two re-operations for CSF leaks, one patient with a slight transient facial nerve paresis and one transient VI nerve paresis. The results compare favorably with results from other authors. Retrosigmoid vestibular nerve section is an effective treatment modality to be offered to patients in whom other modalities have failed. Information about the efficacy and leniency of the treatment should be given to the patient's organization in order to diminish the fear of an intracranial intervention. Surgical experience is necessary in order obtain good results, the number of patients needing the operation is small and centralization of the treatment is mandatory.

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

“…Hearing loss is significantly high in intratympanic gentamycin compared with VN (12). The rate of hearing deterioration was low (9.5%) in our study, and this is comparable with the previous reports of hearing after VN (13)(14)(15)(16). Hearing preservation rate is high in VN (17).…”

Caloric Function After Endolymphatic Sac Surgery

“…In a recent paper, intratympanic gentamicin achieved complete resolution of vertigo in five patients who had undergone ELSS 16 . Although the vertigo control with vestibular neurectomy and gentamicin treatment is higher, there may be considerable imbalance after these procedures 17,18 . A significant concern with ablative procedures that result in total unilateral vestibular deafferentation is the possibility of development of Ménière's disease in the contralateral ear in the future, resulting in a vestibularly crippled patient.…”

“…16 Although the vertigo control with vestibular neurectomy and gentamicin treatment is higher, there may be considerable imbalance after these procedures. 17,18 A significant concern with ablative procedures that result in total unilateral vestibular deafferentation is the possibility of development of Ménière's disease in the contralateral ear in the future, resulting in a vestibularly crippled patient. ELSS, on the other hand, without causing significant effects on the vestibular system, as shown by our data, is a reasonable initial surgical alternative in Ménière's patients who have failed medical management.…”

Endolymphatic Sac Decompression as a Treatment for Meniere's Disease

“…Labyrinthectomy and vestibular neurectomy have long been the gold standard for management of disabling vertigo in patients with Meniere's disease because these procedures have proven to reduce or eliminate episodic vertigo in a high percentage of patients 8 . However, these procedures have a relatively high surgical morbidity and can lead to complete hearing loss and permanent vestibular injury with resulting ataxia and imbalance 9,10 . Furthermore, these procedures are typically performed only at major medical centers by subspecialists; thus, they are less accessible to patients in small communities.…”