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Vestibular Neurectomy

  • Author: Jayita Poduval, MS, MBBS, DNB(ENT), DORL; Chief Editor: Arlen D Meyers, MD, MBA  more...
 
Updated: Jan 17, 2014
 

Background

Complete ablation of the peripheral vestibular apparatus or de-afferentation by sectioning of the vestibular nerve leads to total loss of function on one side, which can then be effectively compensated by central mechanisms. This aims to bring about a constant and long-lasting state of equilibrium that would not be possible if the vestibular input were fluctuating.

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Indications

Indications are as follows:

The most common indication for vestibular neurectomy is Meniere disease not responding to medical treatment for over 6 months and causing incapacitating attacks of vertigo.

In unilateral Meniere disease, patients with functional hearing are treated by vestibular neurectomy via the middle fossa or posterior approaches, whereas those with profound hearing loss may be offered translabyrinthine cochleovestibular neurectomy.

In bilateral Meniere disease, the surgery is done on the worse side, while some centers may also perform the surgery bilaterally.

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Contraindications

Contraindications are as follows:

  • Only hearing ear
  • Central vestibular dysfunction
  • Poor medical condition
  • Age more than 70 years is a relative contraindication.
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Technical Considerations

Outcomes

Although vestibular neurectomy has the highest success rate among all the different surgical procedures performed for the treatment of Meniere disease (the others being sac decompression with shunting, cochleosacculotomy, and labyrinthectomy), recurrent vertigo may occur due to various causes such as incomplete nerve section, neuroma formation, unsatisfactory compensation processes, vestibular dysfunction in the contralateral ear, nerve regeneration, and failure to diagnose nonotologic vertigo.[1] Also, vestibular neurectomy, and also the other surgical procedures, produce better results in correctly diagnosed Meniere disease than in other vestibular causes of vertigo.[1]

Counseling plays a major role in both the preoperative and postoperative phases because patients more or less exchange spontaneous vertigo for a constant sense of disequilibrium, overall reducing the quality of life. In cases of TLVNS, any residual hearing, however poor, is sacrificed, and the patient must accept this outcome as well.[1]

Other factors, such as advanced age (which may hinder central compensatory mechanisms), contralateral tinnitus, the onset of vertigo as the first symptom in Meniere disease, and the presence of eye disease, are also associated with poorer results following surgery.[1]

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Contributor Information and Disclosures
Author

Jayita Poduval, MS, MBBS, DNB(ENT), DORL Assistant Professor, Department of ENT, Pondicherry Institute of Medical Sciences, India

Disclosure: Nothing to disclose.

Specialty Editor Board

Francisco Talavera, PharmD, PhD Adjunct Assistant Professor, University of Nebraska Medical Center College of Pharmacy; Editor-in-Chief, Medscape Drug Reference

Disclosure: Received salary from Medscape for employment. for: Medscape.

Chief Editor

Arlen D Meyers, MD, MBA Professor of Otolaryngology, Dentistry, and Engineering, University of Colorado School of Medicine

Arlen D Meyers, MD, MBA is a member of the following medical societies: American Academy of Facial Plastic and Reconstructive Surgery, American Academy of Otolaryngology-Head and Neck Surgery, American Head and Neck Society

Disclosure: Serve(d) as a director, officer, partner, employee, advisor, consultant or trustee for: Cerescan;RxRevu;SymbiaAllergySolutions<br/>Received income in an amount equal to or greater than $250 from: Symbia<br/>Received from Allergy Solutions, Inc for board membership; Received honoraria from RxRevu for chief medical editor; Received salary from Medvoy for founder and president; Received consulting fee from Corvectra for senior medical advisor; Received ownership interest from Cerescan for consulting; Received consulting fee from Essiahealth for advisor; Received consulting fee from Carespan for advisor; Received consulting fee from Covidien for consulting.

References
  1. Endolymphatic Sac Shunt, Labyrinthectomy and Vestibular Nerve Section in Meniere’s Disease. Meniere’s Disease. Otolaryngological Clinics of North America. October 2010. 43:5.

  2. Chapter 35-Middle cranial fossa-vestibular neurectomy; Chapter 36-Retrolabyrinthine and retrosigmoid vestibular neurectomy. Otologic Surgery-Brackmann, Shelton and Arriaga. 3rd Edn.

  3. Fisch U, Mattox D. Microsurgery of the Skull Base. New York: Thieme; 1988.

  4. Anatomy and Ultrastructure of the Human Ear. Basic Sciences. Scott-Brown’s Otolaryngology. 6th. 1:

  5. Silverstein H, Nichols ML, Rosenberg S, Hoffer M, Norrell H. Combined retrolabyrinthine-retrosigmoid approach for improved exposure of the posterior fossa without cerebellar retraction. Skull Base Surg. 1995. 5(3):177-80. [Medline].

  6. Li CS, Lai JT. 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. [Medline].

 
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