Wide surgical exposure for singular neurectomy in the treatment of benign positional vertigo

Since 1972, singular neurectomy has been performed on 58 patients who had classical benign positional vertigo. The procedure is done under general anesthesia; a wide postauricular exposure is made and the external auditory canal is maximally enlarged until the vertical portion of the facial nerve is identified. This gives an excellent view of the round window niche. Our results indicate vertigo was completely cured in 80% of the cases and improved in 17%. There has been no incidence of total hearing loss in the last 49 cases and only 3 of 49 patients (6%) had sensorineural loss. Although singular neurectomy can be mastered, it will remain a procedure done by few surgeons. The wide exposure technique is safer for preservation of cochlear function and the posterior ampullary nerve is easier to find than using the transmeatal approach as described by Gacek.