An evolution of approach in vestibular neurectomy

Area of Science:

• Neurosurgery
• Otolaryngology
• Vestibular Nerve Surgery

Background:

• Retrolabyrinthine vestibular neurectomy (RVN) introduced in 1978 had good results.
• Retrosigmoid-internal auditory canal (IAC) vestibular neurectomy (1985) improved nerve transection but caused significant headaches in 75% of patients.

Purpose of the Study:

• To report the technique, results, and complications of a combined retrolab-retrosigmoid vestibular neurectomy.
• To evaluate the efficacy of this combined approach in managing vertigo and reducing postoperative headaches.

Main Methods:

• Development of a combined retrolab-retrosigmoid approach incorporating the best aspects of previous techniques.
• Surgical technique involves removing bone over the lateral venous sinus (LVS), performing a limited mastoidectomy, and opening dura behind the LVS.
• Retraction of the LVS exposes the cerebellopontine angle (CP angle), allowing vestibular nerve sectioning in the CP angle or IAC based on cleavage plane presence.

Main Results:

• Excellent vertigo control achieved with the combined procedure.
• Postoperative headache incidence reduced to 10%, a significant improvement over the retrosigmoid-IAC approach.

Conclusions:

• The combined retrolab-retrosigmoid vestibular neurectomy is an effective surgical option for vestibular nerve sectioning.
• This technique successfully balances excellent vertigo control with a markedly reduced incidence of debilitating postoperative headaches.