Selective vestibular neurotomy for Meniére's disease: a neurosurgical procedure?

The objective of this paper is to report the authors' experience with a 1.5-cm suboccipital craniotomy for selective vestibular neurotomy. Data were collected on 19 consecutive patients undergoing selective vestibular neurotomy for Meniére's disease, between June 1988 and January 2004, performed by a neurosurgeon. There were 10 males and nine females. Ages ranged from 35 to 69 years (median 55). All patients had preoperative imaging, audiometric and caloric assessments. Patients were assessed postoperatively for residual vertigo and surgical complications. All patients had repeat audiometric and caloric evaluation postoperatively. Ten patients had excellent (mild residual deafness, no vertigo) and nine had good (no vertigo attacks, mild postural dizziness) results. Hearing was preserved at preoperative levels in 18 patients and improved in one patient. There were two CSF leaks--one settled with lumbar drainage and the other required wound re-exploration. Two patients developed transient facial weakness. There were no deaths. Selective vestibular neurotomy can be performed through a 1.5-cm suboccipital craniotomy without the need for an endoscope. It is a simple, safe and highly successful procedure for controlling vertigo attacks in intractable Meniére's disease. This procedure preserves hearing and should be considered for those refractory to medical treatments.