Retrosigmoid approach for vestibular neurectomy in Meniere’s disease

Dipartimento di Neuroscienze, Università degli Studi di Torino, Torino, Piedmont, Italy
Acta Neurochirurgica (Impact Factor: 1.77). 03/2005; 147(4):401-404. DOI: 10.1007/s00701-004-0431-0


Background. Vestibular nerve section is considered to be the most effective surgical procedure to control intractable symptoms secondary to Menière’s disease (MD). This study was developed to analyze the adequacy of retrosigmoid vestibular neurectomy in terms of vertigo control, hearing preservation and clinical complications of this procedure.
Methods. A retrospective review was carried out on 14 patients affected by definite unilateral MD who underwent vestibular neurectomy via the retrosigmoid approach.
Findings. One patient was lost from follow-up; another one had only a short postoperative observation. At follow-up performed on 12 cases, no patients reported any crisis of acute vertigo. Four patients were free from any vestibular symptoms, while 8 reported some slight gait disturbances. Hearing function was preserved in 10 patients and improved in 2. 1 year postoperative vestibular function was absent at the side operated on and unchanged on the other side in all the cases.
Conclusions. Vestibular neurectomy via the retrosigmoid approach can be considered a safe and effective procedure in relieving medically refractory vertigo in Menière’s disease, while preserving hearing.

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    ABSTRACT: 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. 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. 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. 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.
    No preview · Article · Aug 2008 · Acta Neurochirurgica
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