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Evaluation of retrosigmoid vestibular neurectomy for intractable vertigo in Ménière's disease: an interdisciplinary review.
Acta Neurochir (Wien). 2008 Jul; 150(7):655-61; discussion 661.AN

Abstract

BACKGROUND

Retrosigmoid vestibular neurectomy is suggested to be the most effective and safe procedure to control intractable vertigo associated with Ménière's disease. The purpose of this study is to report the excellent efficacy of vertigo control, the good preservation of hearing, the rare complications and the simplicity of retrosigmoid vestibular neurectomy performed by an interdisciplinary team of neurosurgery and otorhinolaryngology experts of our teaching hospital.

METHODS

Seventy-three patients with Ménière's disease who were refractory to medication or other surgical therapy were consecutively operated on over a period of 7 years. All the patients were referred to the senior author (CSL) for the surgery and were followed-up by the same neurootologist (JTL). The retrosigmoid approach for selective vestibular neurectomy was the only surgical method used in our neurosurgical facility. During surgery the separation line was made just at the cochleo-vestibular cleavage plane on the cochlear nerve to achieve a more complete sectioning of the vestibular fibres. To ensure accurate and complete data collection, patient data was prospectively entered into an electronic database, which was used subsequently for analysis of vertigo control, preservation of hearing, improvement in functional levels, and surgical complications.

RESULTS

Long-term excellent and good vertigo control were achieved in 69 (94.5%) and 4 (5.5%) patients respectively. Hearing was preserved to within 10 dB of the pre-operative pure-tone thresholds in 91.8% of patients at 1 month after the surgery. The functional levels improved to level 1 by a reduction of 3-5 points and became stabilised by 2 years of follow-up in all of our patients. No patient was worse post-operatively. Complications were uncommon and included superficial wound infection and transient partial facial paralysis in one patient each. Total hearing loss did not occur post-operatively. The mean operating time was 70 min.

CONCLUSION

Selective vestibular neurectomy via the retrosigmoid approach is an effective and simple neurosurgical procedure for the control of intractable vertigo in Ménière's disease while preserving hearing.

Authors+Show Affiliations

Service of Neurosurgery, Kuang-Tien General Hospital, Taichung, Taiwan.No affiliation info available

Pub Type(s)

Journal Article

Language

eng

PubMed ID

18536995

Citation

Li, C-S, and J-T Lai. "Evaluation of Retrosigmoid Vestibular Neurectomy for Intractable Vertigo in Ménière's Disease: an Interdisciplinary Review." Acta Neurochirurgica, vol. 150, no. 7, 2008, pp. 655-61; discussion 661.
Li CS, Lai JT. Evaluation of retrosigmoid vestibular neurectomy for intractable vertigo in Ménière's disease: an interdisciplinary review. Acta Neurochir (Wien). 2008;150(7):655-61; discussion 661.
Li, C. S., & Lai, J. T. (2008). Evaluation of retrosigmoid vestibular neurectomy for intractable vertigo in Ménière's disease: an interdisciplinary review. Acta Neurochirurgica, 150(7), 655-61; discussion 661. https://doi.org/10.1007/s00701-007-1462-0
Li CS, Lai JT. Evaluation of Retrosigmoid Vestibular Neurectomy for Intractable Vertigo in Ménière's Disease: an Interdisciplinary Review. Acta Neurochir (Wien). 2008;150(7):655-61; discussion 661. PubMed PMID: 18536995.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Evaluation of retrosigmoid vestibular neurectomy for intractable vertigo in Ménière's disease: an interdisciplinary review. AU - Li,C-S, AU - Lai,J-T, Y1 - 2008/06/09/ PY - 2007/01/05/received PY - 2007/10/22/accepted PY - 2008/6/10/pubmed PY - 2008/9/5/medline PY - 2008/6/10/entrez SP - 655-61; discussion 661 JF - Acta neurochirurgica JO - Acta Neurochir (Wien) VL - 150 IS - 7 N2 - BACKGROUND: Retrosigmoid vestibular neurectomy is suggested to be the most effective and safe procedure to control intractable vertigo associated with Ménière's disease. The purpose of this study is to report the excellent efficacy of vertigo control, the good preservation of hearing, the rare complications and the simplicity of retrosigmoid vestibular neurectomy performed by an interdisciplinary team of neurosurgery and otorhinolaryngology experts of our teaching hospital. METHODS: Seventy-three patients with Ménière's disease who were refractory to medication or other surgical therapy were consecutively operated on over a period of 7 years. All the patients were referred to the senior author (CSL) for the surgery and were followed-up by the same neurootologist (JTL). The retrosigmoid approach for selective vestibular neurectomy was the only surgical method used in our neurosurgical facility. During surgery the separation line was made just at the cochleo-vestibular cleavage plane on the cochlear nerve to achieve a more complete sectioning of the vestibular fibres. To ensure accurate and complete data collection, patient data was prospectively entered into an electronic database, which was used subsequently for analysis of vertigo control, preservation of hearing, improvement in functional levels, and surgical complications. RESULTS: Long-term excellent and good vertigo control were achieved in 69 (94.5%) and 4 (5.5%) patients respectively. Hearing was preserved to within 10 dB of the pre-operative pure-tone thresholds in 91.8% of patients at 1 month after the surgery. The functional levels improved to level 1 by a reduction of 3-5 points and became stabilised by 2 years of follow-up in all of our patients. No patient was worse post-operatively. Complications were uncommon and included superficial wound infection and transient partial facial paralysis in one patient each. Total hearing loss did not occur post-operatively. The mean operating time was 70 min. CONCLUSION: Selective vestibular neurectomy via the retrosigmoid approach is an effective and simple neurosurgical procedure for the control of intractable vertigo in Ménière's disease while preserving hearing. SN - 0942-0940 UR - https://www.unboundmedicine.com/medline/citation/18536995/Evaluation_of_retrosigmoid_vestibular_neurectomy_for_intractable_vertigo_in_Ménière's_disease:_an_interdisciplinary_review_ L2 - https://dx.doi.org/10.1007/s00701-007-1462-0 DB - PRIME DP - Unbound Medicine ER -