Cochleovestibular nerve compression syndrome. II. Vestibular nerve histopathology and theory of pathophysiology

The present study was undertaken to systematically examine and characterize pathological changes in vestibular nerve specimens obtained at surgery in patients with symptomatic cochleovestibular nerve compression syndrome (CNCS). Vestibular nerves were obtained in six cases of CNCS and were intermingled with vestibular nerves obtained in cases of Meniere's disease. All of the nerve specimens were coded and reviewed microscopically in a blind-study fashion by the neuropathologist. The vestibular nerves obtained from CNCS cases showed significant endoneurial fibrosis, compared to controls (specimens from patients with Meniere's disease). Based on observations in this study, as well as the clinical symptoms and audiovestibular test findings in these patients, a theory of pathophysiology in CNCS of the cochleovestibular nerve is proposed. The implications of this theory are discussed with respect to the diagnosis of CNCS.