Long-Term Follow-Up after Middle Fossa Vestibular Neurectomy for Menière’s Disease

Iurato, S.; Onofri, Marina

doi:10.1159/000276727

Cited by 9 publications

(7 citation statements)

References 6 publications

(10 reference statements)

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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: 72%

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: 72%

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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“…It can also be applied as an initial surgery when the patient is experiencing drop attacks. VN causes relief in vertigo in more than 90%, and the results are better than with endolymphatic sac surgery (18). When the other vertigo control techniques have failed and serviceable hearing is present, VN is an excellent option that can be recommended for vertigo control and hearing preservation and to increase the quality of life (19).…”

Section: Discussionmentioning

confidence: 99%

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

Göksu

Yılmaz

Bayramoğlu

et al. 2005

Otology &Amp; Neurotology

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“…Anfangsjahren noch eine gewisse postoperative Mortalität berichtet wurde, so ist die Komplikationsrate in neuerer Zeit deutlich gesunken [182,184,[187][188][189][190][191][192][193][194]. Mögliche Gründe für ein Therapieversagen sind ▶ eine Restinnervation aufgrund nicht vollständiger vestibulärer Deafferenzierung [195], beruhend auf den Tatsachen, dass eine präzise "Spaltung" der vestibulären von den kochleären Fasern technisch schwierig sein kann und einige vestibuläre Fasern in einer "Überlappungszone" mit dem N. cochlearis verlaufen [196].…”

Section: Elektrokochleografie ▼unclassified

“…Allerdings hat eine partielle Mitresektion kochleärer Fasern den Therapieerfolg nicht verbessert. ▶ das Auftreten einer bilateralen Menière-Erkrankung im Verlauf [190]. Dennoch berichtet Pappas in einer Langzeitstudie über eine Erfolgsquote von 90 %, obwohl 22 % seiner Patienten einen bilateralen Morbus Menière entwickelten [192].…”

Section: Elektrokochleografie ▼unclassified

Morbus Menière

Plontke¹,

Gürkov²

2015

Laryngo-Rhino-Otol

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Menière`s disease is one of the most common inner ear and vestibular disorders. It is defined as the idiopathic syndrome of endolymphatic hydrops (ELH). Despite the development of several different animal models of ELH, its etiology and pathogenesis is still unresolved. In humans, endolymphatic hydrops may occur spontaneously or as a consequence of specific disorders with distinct inner ear pathologies, e. g., infectious labyrinthitis, noise induced hearing loss or vestibular schwannoma. Recent imaging studies using MRI have shown that hydropic ear disease is associated not only with the full triad of vertigo, hearing, loss and tinnitus/aural pressure, but also with inner ear symptoms that do not fulfill the clinical criteria of definite Menière's disease as set forth by the AAO-HNS. Therefore, terms like "atypical" or "cochlear"/"vestibular" Menière's disease or "forme fruste" should be avoided and the term "Menière's disease" should universally be applied according only to these guidelines. Besides that, the recent possibility of visualizing endolymphatic hydrops on MRI and thereby ascertaining the diagnosis in difficult cases and new audiovestibular function tests for the indirect detection of endolymphatic hydrops show promising results. Evidenced based reviews of currently available therapeutic options still reveal many uncertainties with regard to efficacy, with the exception of the ablative therapies, e. g., intratympanic gentamicin application.

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Long-Term Follow-Up after Middle Fossa Vestibular Neurectomy for Menière’s Disease

Cited by 9 publications

References 6 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

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

Morbus Menière

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