Video endoscopy-assisted vestibular neurectomy: a new approach to the eighth cranial nerve

Disequilibrium, ranging from lightheadedness to severe vertigo, is frequently of great concern to the patients with a variety of inner ear diseases, and may cause occupational and social disability. Vestibular nerve section may be considered when vestibular symptoms are resistant to medical therapy and associated with serviceable hearing in the involved ear. During the last century, numerous authors described several routes for intracranial section of the eighth nerve, such as lateral suboccipital craniotomy, middle cranial fossa approach, and retrolabyrinthine approach to the vestibular fossa. Control of vertigo by all routes to the vestibular nerve has a success rate of 80% to 90%. The potential for endoscopic approach to intracranial cavities was recognized early in this century but, due to technical limitations, was largely abandoned after a few attempts. Advances in optics, and the introduction of very fine instruments made endoscopy worth reconsideration. Since the early 1980s, rigid endoscopes have been used in otorhinolaryngology for paranasal sinus surgery and the visualization of the facial and vestibulocochlear nerves during acoustic tumor surgery. We performed endoscopic section of the vestibular nerve through a retrolabyrinthine approach in two cadavers and in two patients with the symptoms of disequilibrium. In the literature survey, we could find no reports on vestibular neurectomy performed by endoscopic technique. We describe technical details of the approach, and conclude that the technique is safe and effective.