Vestibular Neurectomy Periprocedural Care

Updated: Jan 03, 2018
  • Author: Jayita Poduval, MS, MBBS, DNB(ENT), DORL; Chief Editor: Arlen D Meyers, MD, MBA  more...
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Periprocedural Care

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. [3]

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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