Microvascular decompression of the cochleovestibular nerve for treatment of tinnitus and vertigo: a systematic review and meta-analysis of individual patient data

Abstract

OBJECTIVE Microvascular decompression (MVD) is regarded as a valid treatment modality in neurovascular conflicts (NVCs) causing, for example, trigeminal neuralgia and hemifacial spasms. An NVC of the cochleovestibular nerve might cause tinnitus and/or vertigo; however, general acceptance of MVD for this indication is lacking. The aim of this study was to investigate the effectiveness, safety, and prognostic factors for success of MVD of the cochleovestibular nerve. METHODS A systematic review and meta-analysis of individual patient data (IPD) were conducted according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses and Individual Patient Data (PRISMA-IPD) guidelines. By a comprehensive search (conducted in January 2016) in MEDLINE, EMBASE, and Google Scholar, eligible studies were identified. The collected outcome was a global measurement of improvement of 1) tinnitus, 2) vertigo, and 3) tinnitus combined with vertigo. For the meta-analysis, IPD were collected from the papers and/or from the authors. IPD were analyzed with logistic regression analysis while accounting for study clustering. RESULTS Thirty-five studies (572 patients) were included. The level of evidence provided by these studies was low. In 28% of patients with tinnitus and 32% of patients with vertigo, complete relief following MVD was reported. Patients with both tinnitus and vertigo had complete relief in 62% of cases. In 11% of patients, ≥ 1 complications were reported. Meta-analysis of IPD (165 patients) demonstrated that patients with both tinnitus and vertigo had a higher chance of success (OR 3.8, 95% CI 1.45-10.10) than patients with tinnitus alone. No other variables were significantly related to success. CONCLUSIONS Due to low success rates, MVD cannot be considered as a standard treatment method for tinnitus or vertigo. Moreover, a substantial complication rate was found. However, patients with combined symptoms had a higher chance of success. When combined symptoms occur, it is more likely that an NVC is the underlying pathology and MVD might be appropriate. Due to the low level of evidence in the included studies, this conclusion must be taken with caution. Further validation is necessary to evaluate whether patients with combined symptoms are indeed better candidates for MVD.

The association between auditory nerve neurovascular conflict and sudden unilateral sensorineural hearing loss

“…In a recent meta-analysis, the success rate for CN8 MVD was 28% for tinnitus and 32% for tinnitus and vertigo, respectively. 19 Interestingly, when those complaints coexisted, MVD was successful in relieving almost twice as many patients (62%) from their symptoms. 19 This finding suggests that when both complaints occur in the same individual, the underlying pathology is more likely to be NVC, thereby making MVD an appropriate procedure.…”

“…19 Interestingly, when those complaints coexisted, MVD was successful in relieving almost twice as many patients (62%) from their symptoms. 19 This finding suggests that when both complaints occur in the same individual, the underlying pathology is more likely to be NVC, thereby making MVD an appropriate procedure. It should be noted that therapeutic success was defined as complete relief from tinnitus and/or vertigo, because partial resolution is not standardized and difficult to compare among studies.…”

Tinnitus Management in Lateral Skull Base Lesions

“…31,56 The most common presentation of epidermoids is headache (67%). 57 The most common cranial nerve deficit at presentation involve the vestibulocochlear nerve but these occur in a fewer percentage of patients compared with VS (50-80%). 32 Trigeminal and facial nerve are involved in 30 to 50%.…”

“…A recent systematic review included 572 patients from 35 studies. 57 They reported that only 28% of patients with tinnitus had complete symptom of relief with MVD with more than one complication noted in 11% of patients. Interestingly, patients with both tinnitus and vertigo had a higher chance of success than in those with tinnitus alone.…”

“…The authors; however, state that a lack of strong evidence in the included studies, mandate that MVD be utilized with caution. 57 Further studies and validation are required to determine if patients with single (tinnitus only) or combined symptoms are indeed better candidates for MVD.…”