Vestibular neurectomy

A brief history of the vestibular neurectomy is given. This treatment modality was introduced in Denmark by us, using the experiences obtained by the use of translabyrinthine treatment modality for vestibular schwannoma surgery. This paper presents our experiences with this type of surgery (translabyrinthine, retrolabyrinthine and retrosigmoid vestibular nerve section) from 1980 to 1996, including 43 operations in 42 patients. The patients had all been treated with conventional methods without success and were all severely handicapped by their attacks of vertigo. The mean age was 51 years, postoperative observation time between 2 and 15 years, with a mean of 6.4 years. The vertigo was controlled in 88% of the patients, while postoperative imbalance occurred in 14 patients, mainly due to the ablation of the vestibular labyrinth and not by episodic vertigo. A total of 39 patients indicated that they were satisfied with the operation. Six patients were deaf before surgery and 92% of the remaining patients retained their preoperative hearing. Postoperative complications were few, including two re-operations for CSF leaks, one patient with a slight transient facial nerve paresis and one transient VI nerve paresis. The results compare favorably with results from other authors. Retrosigmoid vestibular nerve section is an effective treatment modality to be offered to patients in whom other modalities have failed. Information about the efficacy and leniency of the treatment should be given to the patient's organization in order to diminish the fear of an intracranial intervention. Surgical experience is necessary in order obtain good results, the number of patients needing the operation is small and centralization of the treatment is mandatory.