[Surgical interventions for ameliorating of equilibrium disorders refractory to conservative therapy]

In cases of vertigo resistant to conservative treatment, surgery can be valuable for labyrinthine fistula, perilymphatic fistula, cupulolithiasis and Menière's disease. For instance, covering a labyrinthine fistula by a fascial graft relieves the vertigo in an amazingly short time. Perilymphatic fistula is verified and treated by tympanotomy and is used for patients with special auditory and/or vestibular features. Cupulolithiasis usually requires no surgical treatment: special postural training will speed recovery, but a few cases need neurectomy of the inferior vestibular nerve. There are several methods of surgical treatment for Menière's disease. In our experience neurectomy of the superior and inferior vestibular nerves on the diseased side together with decompression of the eighth cranial nerve via an extended transtemporal approach to the middle fossa is an excellent method of treating patients with vertigo attacks.