Retrosigmoid approach for vestibular neurectomy in Meniere?s disease

Perez, Ronen; Ducati, Alessandro; Garbossa, Diego; Benech, Franco; Fontanella, Marco Maria; Canale, Andrea; Albera, Roberto

doi:10.1007/s00701-004-0431-0

Cited by 12 publications

(15 citation statements)

References 6 publications

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“…In fact, the largest series of MD surgical therapy are published by centers that gather patients specifically sent for surgery, but obviously their sample are not useful to evaluate the true rate of different therapeutic options in a MD population. In this paper, it was not our intention to discuss about results, in terms of resolution of vertigo and residual symptomatology; these results have been presented elsewhere [15]. The presentation of results referred to MT and ITG was necessary in order to explain how patients arrived to ask VN.…”

Section: Discussionmentioning

confidence: 96%

“…Moreover, these techniques allow preserving the residual hearing, even if severely compromised; this may be of particular importance in case of MD bilateralization or appearance of severe hearing loss due to other causes at the better ear. Several studies have demonstrated the efficacy of ITG and VN in vertigo control [15][16][17][18], with a higher rate of definitive results for VN [15,20,21]. On the other hand, ITG is preferred by patients since it is less traumatic and can be carried out in outpatients.…”

Section: Discussionmentioning

confidence: 99%

“…The main advantage of VN versus ITG is that, in the majority of patients, vertigo is definitively controlled [15]. Regarding the surgical technique, several approaches for VN have been proposed.…”

Section: Introductionmentioning

confidence: 99%

See 2 more Smart Citations

Surgical indication in Menière’s disease therapy: clinical and epidemiological aspects

Albera

Canale

Parandero

et al. 2011

Eur Arch Otorhinolaryngol

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The aim of this study was to evaluate the frequency of surgical approach in a population of patients affected by definite Menière's disease (MD). In the majority of patients, relief from vertigo attacks can be achieved by means of medical therapy (MT). In cases in which MT fails surgery may offer relief to vertigo. The most applied surgical procedures are intratympanic gentamicin (ITG) and vestibular neurectomy (VN), based on vestibular deafferentation. Until now, the real incidence of the different therapeutic approaches for MD has not been evaluated. The study design was a retrospective study. The study was performed in 177 patients affected by definite MD. Subjects referred directly for surgery by other centers were excluded from the study. All the patients were medically treated with salt restriction and diuretics. In case of MT failure, surgical therapy, ITG or retrosigmoid VN were proposed. In the 75% of cases, the only therapeutic approach was MT, while in 20% of cases we carried out ITG and in 5% VN. In 33% of VN group, this operation was carried out after ITG failure and in 67% as the first surgical approach. The VN group was characterized by younger age and higher disability degree. The primary therapy in definite MD seems to be MT. Ablative therapy represents the second choice: ITG was carried out in 80% of cases, while VN was performed in 20%.

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Section: Discussionmentioning

confidence: 96%

Section: Discussionmentioning

confidence: 99%

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Surgical indication in Menière’s disease therapy: clinical and epidemiological aspects

Albera

Canale

Parandero

et al. 2011

Eur Arch Otorhinolaryngol

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“…Vestibular input to the CNS is normally bilateral and symmetrical. 12,25,34 Symptoms of vertigo typically develop when vestibular disease on 1 side causes this input to become asymmetrical. The rationale for ablating the peripheral vestibular system, therefore, is to completely eliminate the abnormal vestibular input from the diseased side.…”

Section: Discussionmentioning

confidence: 99%

“…8,11,13,25,27 This approach allowed for sectioning of both the superior and inferior vestibular nerves with good symptomatic control of vertigo but was complicated by high rates of facial nerve paralysis and deafness. 7,22,24,25 Silverstein and Norrel 30 subsequently described the retrolabyrinthine approach for vestibular nerve sectioning. This approach allowed for excellent visualization of the cranial nerve VIII complex in the CPA with minimal retraction of the cerebellum.…”

Section: Discussionmentioning

confidence: 99%

Two-handed endoscopic-directed vestibular nerve sectioning: case series and review of the literature

Cutler

Kaloostian

Ishiyama

et al. 2012

JNS

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ObjectVestibular nerve sectioning is an accepted surgical treatment option for patients with medically refractory Ménière disease. In this paper the authors introduce and evaluate a 2-handed endoscopic-directed technique for vestibular nerve section.MethodsEleven patients underwent a retrosigmoid craniectomy for endoscopic-directed vestibular nerve sectioning as treatment for intractable vertigo associated with Ménière disease. In all patients, identification and dissection of the cranial nerve VII/VIII complex was performed entirely under endoscopic guidance. The authors used the specially designed Frazee II neuroendoscope, consisting of a traditional endoscope lens with a microsuction attachment.ResultsVestibular nerve sectioning was completed in all 11 patients. Postoperative improvement in vertiginous episodes was achieved in 10 patients (91%). Auditory function was noted to be worse postoperatively in only 1 patient (9%). The same patient also developed a House-Brackmann Grade III facial nerve palsy, which improved gradually over time. There were no further complications, including no delayed CSF leaks.ConclusionsThe endoscopic-directed approach represents a safe and effective method for performing vestibular nerve sectioning. Until now, the endoscope has been used primarily as an adjunct to the operating microscope in surgery at the cerebellopontine angle. In addition, previous endoscopic techniques typically require a third hand to manipulate the endoscope. With the 2-handed endoscopic-directed technique, however, the endoscope is used as the primary means of visualization, and the unique design of this endoscope allows for a bimanual procedure without the requirement of a cosurgeon. Advantages of using this technique compared with the microscope include superior brightness at close distances, greater depth of field, increased maneuverability within small regions, and an improved ability to visualize objects not in a direct line of sight. Among other things, this allows for minimally invasive openings, decreased cerebellar retraction, and better identification of nerve cleavage planes and vascular anatomy.

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Evaluation of retrosigmoid vestibular neurectomy for intractable vertigo in Ménière’s disease: an interdisciplinary review

Lai

2008

Acta Neurochir (Wien)

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Retrosigmoid approach for vestibular neurectomy in Meniere?s disease

Abstract: Vestibular neurectomy via the retrosigmoid approach can be considered a safe and effective procedure in relieving medically refractory vertigo in Meniere's disease, while preserving hearing.

Cited by 12 publications

References 6 publications

Surgical indication in Menière’s disease therapy: clinical and epidemiological aspects

Surgical indication in Menière’s disease therapy: clinical and epidemiological aspects

Two-handed endoscopic-directed vestibular nerve sectioning: case series and review of the literature

Evaluation of retrosigmoid vestibular neurectomy for intractable vertigo in Ménière’s disease: an interdisciplinary review

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