Retrosigmoid-internal auditory canal approach vs. retrolabyrinthine approach for vestibular neurectomy

A new procedure, the retrosigmoid-internal auditory canal (RSG-IAC) vestibular neurectomy, has been developed, presented, and compared with the retrolabyrinthine vestibular neurectomy (RVN). The RSG-IAC involves a 3 cm retrosigmoid craniotomy removal of the posterior wall of the internal auditory canal (IAC) to the singular canal, with transection of the superior vestibular nerve and the posterior ampullary nerve. This effects a complete denervation of the vestibular labyrinth and preserves the patient's hearing. All 11 patients with Meniere's disease were cured of vertigo. Hearing was preserved to within 10 dB of the preoperative pure-tone average (PTA) in 9 of 11 cases. There were no serious complications and no cases of facial paralysis or total hearing loss. The major postoperative problem is persistent headache that necessitates medication. These results compare favorably with--and may be better than those noted after--the RVN procedure. The RSG-IAC vestibular neurectomy is an important improvement in the evolution of vestibular neurectomy for the treatment of vertigo. A prospective study is now in progress to determine which procedure--the RSG-IAC or RVN--best fulfills the goals of vestibular neurectomy.