Neurotomie vestibulaire vs. labyrinthectomie chimique dans la maladie de Menière invalidante

Morel, Nils; Dumas, Georges; Nguyen, D.-Q.; Mohr, E.; Hitter, A.; Schmerber, S.

doi:10.1016/s0003-438x(05)82361-8

Cited by 10 publications

(4 citation statements)

References 19 publications

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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%

“…The rate of partial deafferentation is very low (2.7%) and is comparable to data in the literature (from 2.5% to 10% of cases). 1,15,18,22,28 It causes a recurrence of vertiginous attacks long after surgery (up to 3 years in this study). In view of this delay in recurrence, the evaluation of the effectiveness of other radical treatments for vestibular function does not seem pertinent before 3 years.…”

Section: Discussionmentioning

confidence: 55%

“…36,37 However, the data in the literature are inconsistent as to its efficacy at 5 years, which varies from 70% to 81%. 38,39 In comparison to VN its efficacy rate always seems lower, whether it is at 2 years (75% in the case of ITG vs 95.8% in the case of VN for Colletti et al 40 ) or at more than 2 years (81% at 2.7 years in the case of ITG vs 93% at 4.9 years in the case of VN for Morel et al 15 ).…”

Section: Discussionmentioning

confidence: 98%

“…Cases of meningitis are also exceptional-in all studies they accounted for less than 1%. 10,20 The rate of total deafness in the literature is extremely low (0%-9%), and seems proportionally lower in cases of retrosigmoid approach (0%-1.7%) 1,15,[17][18][19] than in cases of retrolabyrinthine approach (0%-2.14%) 13,18,33 or the middle fossa approach (0%-9%). [8][9][10][11][12]14 No total deafness and no permanent facial paralysis were observed in our study; the frequency of the latter complication appears to be lower in the case of the posterior fossa approach (0.04% for peripheral facial paralysis, of which 100% were regressive) than of the middle fossa (7% for peripheral facial paralysis, of which 3.75% were permanent).…”

Section: Discussionmentioning

confidence: 99%

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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%

Section: Discussionmentioning

confidence: 55%

Section: Discussionmentioning

confidence: 98%

Section: Discussionmentioning

confidence: 99%

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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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Evaluation of vestibular function following endolymphatic sac surgery

Gendre

Bourget-Aguilar

Calais

et al. 2021

Eur Arch Otorhinolaryngol

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Vestibular and audiometric results after endolymphatic mastoid shunt surgery in patients with Menière’s disease

Spiegel

Stoycheva

Weiss

et al. 2022

Eur Arch Otorhinolaryngol

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Purpose Treatment of Menière’s Disease (MD) comprises an array of both non-destructive and destructive treatment options. In patients who are therapy–refractory to non-destructive medical treatment, endolymphatic mastoid shunt surgery (EMSS) is both recommended and debated controversially. The aim of this study was to investigate safety in terms of hearing, vestibular function, complication rate, and efficacy with regards to vertigo control of EMSS in patients with MD according to the current diagnostic criteria of 2015. Methods Retrospective analysis of 47 consecutive patients with definite or probable MD with description of demographic parameters, pre- and postoperative MD treatment, pre- and postoperative audiometric (pure tone audiometry) and vestibular (caloric testing) results. The parameters were compared between patients with and without postoperative vertigo control. Results 31/47 patients (66.0%) had improved vertigo control postoperatively. Postoperative hearing and vestibular preservation were predominantly stable. No significant differences between patients with improved vertigo control and patients with no change or worse vertigo episodes were found. In the treatment refractory group, 4 patients required a revision EMSS and 6 a destructive MD treatment (5 gentamicin intratympanically, 1 labyrinthectomy). No peri- or postsurgical complications were reported. Conclusions EMSS was found to be beneficial in two thirds of the patients with definite or probable Morbus Menière and a safe procedure regarding hearing and vestibular preservation with no postoperative complications. Therefore, EMSS should be considered before inducing destructive treatment options, such as intratympanic gentamicin application or labyrinthectomy.

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Neurotomie vestibulaire vs. labyrinthectomie chimique dans la maladie de Menière invalidante

Cited by 10 publications

References 19 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

Evaluation of vestibular function following endolymphatic sac surgery

Vestibular and audiometric results after endolymphatic mastoid shunt surgery in patients with Menière’s disease

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