Functional Results and Quality of Life After Retrosigmoid Vestibular Neurectomy in Patients With Ménière’s Disease

Schlegel, M.; Vibert, Dominique; Ott, Sebastian Robert; Häusler, Rudolf; Caversaccio, Marco

doi:10.1097/mao.0b013e318268d1cd

Cited by 23 publications

(16 citation statements)

References 24 publications

(22 reference statements)

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“…Overall, the efficacy of RLVNS (i.e., complete resolution of episodic vertigo) in our series was 93%; this is in line with rates reported in the literature 10, 15,17,18 (see ►Table 2). The patients who had imbalance after surgery experienced improvement in their disequilibrium symptoms after completing outpatient vestibular physical therapy.…”

Section: Discussionsupporting

confidence: 91%

Vestibular Neurectomy for Intractable Vertigo: Case Series and Evaluation of Role of Endoscopic Assistance in Retrolabyrinthine Craniotomy

2018

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Objective This study evaluates the utility of endoscopy for retrolabyrinthine vestibular nerve section (RLVNS). Design/Setting This is a retrospective review for RLVNSs by the senior author. The endoscope's utility was assessed and assigned a grade based on operative findings. Participants/Main Outcome Measures Fifteen patients (eight males and seven females; 53 and 47%, respectively) were identified with mean age 56.7 years. Indications included Ménière's disease (MD) in 12 of 15 patients (80%), uncompensated vestibular neuritis in 2 patients (13%), and other vestibular neuropathy in 1 patient (7%). Vertigo resolved in 14 of 15 patients (93%). Complications included decreased hearing in two patients (13%) and deep venous thrombosis in one patient (7%). There were no facial nerve complications or mortalities. Results Sectioning vestibular division of the vestibular–cochlear nerve was achieved without perceived benefit of endoscopy in the 80% of cases (grade 0, n = 12). Endoscopy was helpful in patients with a small mastoid (grade 1, n = 2, 13.3%), and deemed necessary where the flocculus of the cerebellum was adherent to the eighth nerve arachnoid at the porus acusticus (grade 2, n = 1, 6.7%). Conclusion RLVNS is a safe and efficacious procedure for the treatment of vertigo; the surgical endoscope may be a useful adjunct in selected cases. Patients with MD may expect the greatest benefit from surgery.

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Section: Discussionsupporting

confidence: 91%

Vestibular Neurectomy for Intractable Vertigo: Case Series and Evaluation of Role of Endoscopic Assistance in Retrolabyrinthine Craniotomy

2018

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“…Several studies have reported the hearing loss rate and vertigo control with vestibular nerve section and gentamicin treatment separately. Schlegel et al 6 have demonstrated that the results after VNS proved to be more consistent than those reported after chemical deafferentation of the labyrinth with aminoglycosides. The outcome after chemical labyrinthectomy using aminoglycosides is often satisfactory, but unpleasant ataxia, more intense tinnitus, and a postoperative decrease in hearing are not rare.…”

Section: Labyrinthectomy Versus Intratympanic Aminoglycosidesmentioning

confidence: 75%

“…Schlegel et al 6 have demonstrated 95.5% of hearing function preservation, and on the vestibular side, the medium to long-term evolution of the operated patients showed that durable suppression or significant improvement of the vertigo was achieved in 90.9% of them. According to the literature, ablative surgical deafferentation, such as vestibular neurectomy, remains the most efficient procedure to treat drop attacks.…”

Section: Vestibular Neurectomymentioning

confidence: 94%

Labyrinthectomy and Vestibular Neurectomy for Intractable Vertiginous Symptoms

Alarcón

Hidalgo

Arévalo

et al. 2017

Int Arch Otorhinolaryngol

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Introduction Labyrinthectomy and vestibular neurectomy are considered the surgical procedures with the highest possibility of controlling medically untreatable incapacitating vertigo. Ironically, after 100 years of the introduction of both transmastoid labyrinthectomy and vestibular neurectomy, the choice of which procedure to use rests primarily on the evaluation of the hearing and of the surgical morbidity. Objective To review surgical labyrinthectomy and vestibular neurectomy for the treatment of incapacitating vestibular disorders. Data Sources PubMed, MD consult and Ovid-SP databases. Data Synthesis In this review we describe and compare surgical labyrinthectomy and vestibular neurectomy. A contrast between surgical and chemical labyrinthectomy is also examined. Proper candidate selection, success in vertigo control and complication rates are discussed on the basis of a literature review. Conclusions Vestibular nerve section and labyrinthectomy achieve high and comparable rates of vertigo control. Even though vestibular neurectomy is considered a hearing sparing surgery, since it is an intradural procedure, it carries a greater risk of complications than transmastoid labyrinthectomy. Furthermore, since many patients whose hearing is preserved with vestibular nerve section may ultimately lose that hearing, the long-term value of hearing preservation is not well established. Although the combination of both procedures, in the form of a translabyrinthine vestibular nerve section, is the most certain way to ablate vestibular function for patients with no useful hearing and disabling vertigo, some advocate for transmastoid labyrinthectomy alone, considering that avoiding opening the subarachnoid space minimizes the possible intracranial complications. Chemical labyrinthectomy may be considered a safer alternative, but the risks of hearing loss when hearing preservation is desired are also high.

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“…House [28] introduced the middle fossa approach. Regardless of the access, the decompression technique had a success rate of up to 90% in the control of vertigo [29][30][31][32][33]. Colletti et al [4] conducted a comparative study on 209 patients who DOI: http://dx.doi.org /10.5772/intechopen.88014 underwent neurectomy, comparing a group of 24 patients who received intratympanic gentamicin (ITG), chemical labyrinthectomy neural ablation therapy.…”

Section: Vestibulocochlear Nerve Neurectomymentioning

confidence: 99%

Surgical Procedures for Ménière’s Disease

Bento¹,

Lopes²

2019

Meniere's Disease [Working Title]

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The aim of this chapter is to present a literature review on some of the main articles describing different interventions for the treatment in patients with progressive intractable Ménière disease symptoms. Even though each paper presents good results in defending its techniques, there have been few well-designed clinical studies, that is, studies involving control groups or long-term observation, in the efficacy of surgery with respect to vertigo control and hearing preservation. Focusing on presenting the different techniques established in the literature, we discuss the main indications and results obtained regarding the control of vertigo and the audiological outcomes after the procedure. Physicians should offer additional treatment strategies for Meniere's disease patients with a long history of limiting symptoms or associated hearing loss. The surgical options for such patients should be considered carefully because surgery can damage the ipsilateral ear and the hearing function of the contralateral ear is often suboptimal. Its importance is that alternatives for treatment can only be offered to a patient when doctor knows them.

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Functional Results and Quality of Life After Retrosigmoid Vestibular Neurectomy in Patients With Ménière’s Disease

Abstract: Retrosigmoid VN is a valuable and safe surgical option to treat disabling MD that has proved resistant to medical treatments. It may also be indicated for patients with preoperative severely impaired thresholds of hearing, in whom a certain hearing gain may be observed.

Cited by 23 publications

References 24 publications

Vestibular Neurectomy for Intractable Vertigo: Case Series and Evaluation of Role of Endoscopic Assistance in Retrolabyrinthine Craniotomy

Vestibular Neurectomy for Intractable Vertigo: Case Series and Evaluation of Role of Endoscopic Assistance in Retrolabyrinthine Craniotomy

Labyrinthectomy and Vestibular Neurectomy for Intractable Vertiginous Symptoms

Surgical Procedures for Ménière’s Disease

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