Vestibular Neurectomy for Intractable Vertigo: Case Series and Evaluation of Role of Endoscopic Assistance in Retrolabyrinthine Craniotomy
22 November 2017
07 July 2018
18 October 2018 (eFirst)
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.
- 1 Brackmann DE, Hitselberger WE. Retrolabyrinthine approach: technique and newer indications. Laryngoscope 1978; 88 (2 Pt 1): 286-297
- 2 House JW, Hitselberger WE, McElveen J, Brackmann DE. Retrolabyrinthine section of the vestibular nerve. Otolaryngol Head Neck Surg 1984; 92 (02) 212-215
- 3 McElveen Jr JT, House JW, Hitselberger WE, Brackmann DE. Retrolabyrinthine vestibular nerve section: a viable alternative to the middle fossa approach. Otolaryngol Head Neck Surg 1984; 92 (02) 136-140
- 4 McLaughlin MR, Jannetta PJ, Clyde BL, Subach BR, Comey CH, Resnick DK. Microvascular decompression of cranial nerves: lessons learned after 4400 operations. J Neurosurg 1999; 90 (01) 1-8
- 5 Megerian CA, Hanekamp JS, Cosenza MJ, Litofsky NS. Selective retrosigmoid vestibular neurectomy without internal auditory canal drill-out: an anatomic study. Otol Neurotol 2002; 23 (02) 218-223
- 6 Wackym PA, King WA, Barker FG, Poe DS. Endoscope-assisted vestibular neurectomy. Laryngoscope 1998; 108 (12) 1787-1793
- 7 King WA, Wackym PA, Sen C, Meyer GA, Shiau J, Deutsch H. Adjunctive use of endoscopy during posterior fossa surgery to treat cranial neuropathies. Neurosurgery 2001; 49 (01) 108-115 , discussion 115–116
- 8 Miyazaki H, Deveze A, Magnan J. Neuro-otologic surgery through minimally invasive retrosigmoid approach: endoscope assisted microvascular decompression, vestibular neurotomy, and tumor removal. Laryngoscope 2005; 115 (09) 1612-1617
- 9 Mostafa BE, El Sharnoubi M, Youssef AM. The keyhole retrosigmoid approach to the cerebello-pontine angle: indications, technical modifications, and results. Skull Base 2008; 18 (06) 371-376
- 10 Cutler AR, Kaloostian SW, Ishiyama A, Frazee JG. Two-handed endoscopic-directed vestibular nerve sectioning: case series and review of the literature. J Neurosurg 2012; 117 (03) 507-513
- 11 Committee on Hearing and Equilibrium guidelines for the evaluation of hearing preservation in acoustic neuroma (vestibular schwannoma). American Academy of Otolaryngology-Head and Neck Surgery Foundation, INC. Otolaryngol Head Neck Surg 1995; 113 (03) 179-180
- 12 Lobo B, Heng A, Barkhoudarian G, Griffiths CF, Kelly DF. The expanding role of the endonasal endoscopic approach in pituitary and skull base surgery: a 2014 perspective. Surg Neurol Int 2015; 6: 82
- 13 Tarabichi M, Nogueira JF, Marchioni D, Presutti L, Pothier DD, Ayache S. Transcanal endoscopic management of cholesteatoma. Otolaryngol Clin North Am 2013; 46 (02) 107-130
- 14 Ozluoglu LN, Akbasak A. Video endoscopy-assisted vestibular neurectomy: a new approach to the eighth cranial nerve. Skull Base Surg 1996; 6 (04) 215-219
- 15 Teufert KB, Doherty J. Endolymphatic sac shunt, labyrinthectomy, and vestibular nerve section in Meniere's disease. Otolaryngol Clin North Am 2010; 43 (05) 1091-1111
- 16 Nguyen CD, Brackmann DE, Crane RT, Linthicum Jr FH, Hitselberger WE. Retrolabyrinthine vestibular nerve section: evaluation of technical modification in 143 cases. Am J Otol 1992; 13 (04) 328-332
- 17 Leveque M, Seidermann L, Tran H, Langagne T, Ulmer E, Chays A. Vestibular function outcomes after vestibular neurectomy in Meniere disease: can vestibular neurectomy provide complete vestibular deafferentation?. Auris Nasus Larynx 2010; 37 (03) 308-313
- 18 Schlegel M, Vibert D, Ott SR, Häusler R, Caversaccio MD. Functional results and quality of life after retrosigmoid vestibular neurectomy in patients with Ménière's disease. Otol Neurotol 2012; 33 (08) 1380-1385
- 19 Teufert KB, Berliner KI, De la Cruz A. Persistent dizziness after surgical treatment of vertigo: an exploratory study of prognostic factors. Otol Neurotol 2007; 28 (08) 1056-1062
- 20 Angeli SI, Telischi FF, Eshraghi AA. Middle fossa vestibular neurectomy for refractory vertigo: less is more. Ann Otol Rhinol Laryngol 2014; 123: 359-364
- 21 Colletti V, Carner M, Colletti L. Auditory results after vestibular nerve section and intratympanic gentamicin for Ménière's disease. 2007 28. 145-151
- 22 Goksu N, Yilmaz M, Bayramoglu I, Bayazit YA. Combined retrosigmoid retrolabyrinthine vestibular nerve section: results of our experience over 10 years. Otol Neurotol 2005; 26: 481-483
- 23 McKenna MJ, Nadol JB, Ojemann RG, Halpin C. Vestibular neurectomy: retrosigmoid-intracanalicular versus retrolabyrinthine approach. Am J Otol 1996; 17: 253-258
- 24 Boyce SE, Mischke RE, Goin DW. Hearing results and control of vertigo after retrolabyrinthine vestibular nerve section. Laryngoscope 1988; 98: 257-261