An analysis of the retrolabyrinthine vs. the retrosigmoid vestibular nerve section

Abstract

Vestibular neurectomy is gaining widespread acceptance as a primary means of controlling medically refractory vertigo. However, debate continues over the adequacy of vestibular neurectomy within the cerebellopontine angle, long-term control, and the most appropriate surgical approach. To address these issues, we retrospectively reviewed 118 patients who underwent vestibular neurectomy between October 1984 and January 1988. Forty-two patients who underwent a retrolabyrinthine approach and 44 patients who underwent a retrosigmoid approach completed a written questionnaire and provided a recent audiogram. According to American Academy of Otolaryngology-Head and Neck Surgery guidelines, complete or substantial vertigo control was achieved and maintained in 95% of patients in both surgical groups. Hearing, tinnitus, and fullness results over the long term are variable. The advantages and disadvantages of the various vestibular neurectomy approaches will be detailed. On review of our results and surgical experience, we now prefer the retrosigmoid approach.

Endoscopia do meato acústico interno pelo acesso retrolabiríntico

“…Uma das possibilidades para melhorar o ângulo de visão linear sobre o MAI é através da craniotomia retrosigmóidea 11,12 , a qual não expõe, à otomicroscopia, de 3 a 4mm da porção lateral do MAI [13][14][15] . Já nos acessos suboccipitais, esta parte obscura varia de 2mm 16,17 até zero 18,19 , conforme a via de acesso aproxima-se da linha sagital mediana do crânio.…”

Meniere’s Disease Treatment

“…In the literature [33][34][35][36][37], vertigo control rates between 78 and over 90% have been reported. The contraindications are rare for this type of surgery, complications can exemplify: loss of CSF, meningitis, cranial Neuropathies, seizures, stroke, and death, in addition to general surgical and anesthetic risks.…”

Vestibular System Disorders

“…However, there has been recently a revival of this procedure. Only in devastating cases, surgical procedures such as selective neurectomie or labyrinthectomy can stop the attacks, but go along with the loss of hearing (Glasscock et al, 1991). Intratympanal gentamicin injection has long been known to be effective in controlling vertigo in Menie`re's patients.…”