Selective Vestibular Neurectomy for Intractable Meniere's Disease

Introduction: Selective vestibular neurectomy (VN) is a quite effective salvage-procedure, introduced by Dandy, to control intractable vertigo associated with Meniere's disease. The higher magnification offered by the endoscopic technique and the advanced intraoperative neuromonitoring allow to obtain the complete section of the vestibular nerve fibers, minimizing the risk of iatrogenic lesion of the facial and cochlear nerves.

Methods: We retrospectively reviewed 30 patients who underwent a combined micro-endoscopic selective VN, previously treated with endolymphatic sac surgery (ELSS). All patients were stratified according to clinical features, assessing pre-operative and postoperative hearing level and quality of life. The time interval between the onset of vertigo and the date of surgery were also considered. Intraoperative neurophysiological monitoring were always used. Control of vertigo after surgery was categorized and post-operative complications were assessed at baseline, 1 week, 3, 6, 9, 12 months and every year after surgery.

Results: All patients had persistent vertigo following a failed ELSS. At the maximum follow-up of 2 years, vertigo disappeared in 26 of 30 patients. Four patients presented occasional tinnitus. Only one patient had CSF leakage, solved with surgical treatment. Auditory function worsened in one patient. In all cases, intraoperative neurophysiological monitoring allowed selective identification of VII and VIII nerves. The use of the endoscope helped to identify the arteriole in the sulcus between cochlear and vestibular components of the VIII nerve and to appreciate the different coloration between vestibular and cochlear nerves.

Conclusion: Selective VN via a pre-sigmoid retrolabyrinthine approach is a safe procedure for intractable MD, with a serviceable hearing function. This procedure has a low rate of complications and ~90% of vertigo control after surgery. The use of endoscope technique and intra-operative neuromonitoring guarantees a selective VN, sparing the cochlear fibers and the facial nerve.

No conflict of interest has been declared by the author(s).

Publication History

Article published online:
15 February 2022