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

Abstract

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.

Anatomic Assessment of the Limits of an Endoscopically Assisted Retrolabyrinthine Approach to the Internal Auditory Canal

“…The endoscope has also been shown to facilitate the removal of epidermoid cysts in the cerebellopontine angle, improve exposure in select case of vestibular nerve section, glossopharyngeal neurectomy, and microvascular decompression. 8,14,15 In a recent laboratory study by our first author (T.J.M. ), endoscopic assistance during drilling of the IAC through the retrolabyrinthine approach allowed for exposure and view of the fundus in eight of eight specimens using a 0-degree endoscope, compared with 0 specimens using a microscope.…”

Stratification of patients with Menière’s disease based on eye movement videos recorded from the beginning of vertigo attacks and contrast-enhanced MRI findings

“…Some patients with MD have EH on CE-MRI, but others do not ( 7 ). Many therapies for MD exist, for example, oral administration of diuretics ( 8 ), intratympanic administration of steroids ( 9 ), intratympanic administration of gentamicin ( 10 ), endolymphatic sac decompression surgery ( 11 ), and vestibular neurectomy ( 12 ). However, there is no evidence for the effectiveness of any of these treatments.…”