J Neurol Surg B 2019; 80(04): 357-363
DOI: 10.1055/s-0038-1670685
Original Article
Georg Thieme Verlag KG Stuttgart · New York

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

Brian S. Chen
1  House Clinic, Los Angeles, California, United States
,
Daniel S. Roberts
1  House Clinic, Los Angeles, California, United States
,
Gregory P. Lekovic
1  House Clinic, Los Angeles, California, United States
› Author Affiliations
Further Information

Publication History

22 November 2017

07 July 2018

Publication Date:
18 October 2018 (eFirst)

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.