CC BY-NC-ND 4.0 · Int Arch Otorhinolaryngol 2017; 21(02): 184-190
DOI: 10.1055/s-0037-1599242
Systematic Review – The Surgical Management of Vestibular Disorders
Thieme-Revinter Publicações Ltda Rio de Janeiro, Brazil

Labyrinthectomy and Vestibular Neurectomy for Intractable Vertiginous Symptoms

Alfredo Vega Alarcón
1  Neurology Center, Centro Médico American British Cowdray, México, DF, Mexico
2  Otorhinolaryngology and Neurotology Department, Instituto Nacional de Neurología y Neurocirugía Dr. Manuel Velasco Suárez, México, DF, Mexico
,
Lourdes Olivia Vales Hidalgo
2  Otorhinolaryngology and Neurotology Department, Instituto Nacional de Neurología y Neurocirugía Dr. Manuel Velasco Suárez, México, DF, Mexico
,
Rodrigo Jácome Arévalo
2  Otorhinolaryngology and Neurotology Department, Instituto Nacional de Neurología y Neurocirugía Dr. Manuel Velasco Suárez, México, DF, Mexico
,
Marite Palma Diaz
1  Neurology Center, Centro Médico American British Cowdray, México, DF, Mexico
2  Otorhinolaryngology and Neurotology Department, Instituto Nacional de Neurología y Neurocirugía Dr. Manuel Velasco Suárez, México, DF, Mexico
› Author Affiliations
Further Information

Publication History

02 December 2016

01 February 2017

Publication Date:
31 March 2017 (online)

  

Abstract

Introduction Labyrinthectomy and vestibular neurectomy are considered the surgical procedures with the highest possibility of controlling medically untreatable incapacitating vertigo. Ironically, after 100 years of the introduction of both transmastoid labyrinthectomy and vestibular neurectomy, the choice of which procedure to use rests primarily on the evaluation of the hearing and of the surgical morbidity.

Objective To review surgical labyrinthectomy and vestibular neurectomy for the treatment of incapacitating vestibular disorders.

Data Sources PubMed, MD consult and Ovid-SP databases.

Data Synthesis In this review we describe and compare surgical labyrinthectomy and vestibular neurectomy. A contrast between surgical and chemical labyrinthectomy is also examined. Proper candidate selection, success in vertigo control and complication rates are discussed on the basis of a literature review.

Conclusions Vestibular nerve section and labyrinthectomy achieve high and comparable rates of vertigo control. Even though vestibular neurectomy is considered a hearing sparing surgery, since it is an intradural procedure, it carries a greater risk of complications than transmastoid labyrinthectomy. Furthermore, since many patients whose hearing is preserved with vestibular nerve section may ultimately lose that hearing, the long-term value of hearing preservation is not well established. Although the combination of both procedures, in the form of a translabyrinthine vestibular nerve section, is the most certain way to ablate vestibular function for patients with no useful hearing and disabling vertigo, some advocate for transmastoid labyrinthectomy alone, considering that avoiding opening the subarachnoid space minimizes the possible intracranial complications. Chemical labyrinthectomy may be considered a safer alternative, but the risks of hearing loss when hearing preservation is desired are also high.