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Vestibular Neurectomy Periprocedural Care

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

Patient Education & Consent

Elements of Informed Consent

Counselling must be given to the patient regarding the indication of the procedure, the surgical approach and its pros and cons, and the outcome and possible complications of the surgery.

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Pre-Procedure Planning

Patient Preparation

Preoperative sedation and premedication is given, usually clonidine, metoclopramide, and midazolam; intravenous ceftriaxone, 2 g intravenously for 24 hours, is started at the time of surgery and continued for the duration of the intravenous infusion, usually for 5 days.[2]

Anesthesia

Hypotensive anesthesia with nitroglycerin or clonidine or both is used in most cases to maintain a systolic blood pressure between 80 mm Hg and 90 mm Hg. Intracranial pressure is controlled by deep anesthesia induced intravenously before introducing inhalation anesthetic and the partial pressure of carbon dioxide is maintained between 30 mm Hg and 40 mm Hg. Mannitol (0.5 mg/kg intravenously) is given throughout the surgery, and dexamethasone ( 4 mg every 8 hours) is given for 4 days. Furosemide is added when necessary.

Intraoperative facial nerve monitoring is used with percutaneous electromyography needles. Hemostasis may be secured using unipolar and bipolar stimulating forceps.

The above steps remain more or less common to all the approaches mentioned.

Positioning

The patient is secured on the operating table under general anaesthesia with endotracheal intubation, in supine position with the head turned to the side.

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Monitoring & Follow-up

Complications include the following:

  • Facial nerve paralysis
  • Cochlear nerve damage-deafness, tinnitus
  • Bleeding
  • Cerebrospinal fluid leak
  • Headache
  • Trismus
  • Recurrence of symptoms/persistent dysequilibrium
  • Wound infection, meningitis, aseptic meningitis, abdominal hematoma
  • Neurological sequelae
  • Hydrocephalus
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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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