Vestibular Nerve Section via Middle Cranial Fossa Approach

Area of Science:

• Neurosurgery
• Otolaryngology
• Vestibular Disorders

Background:

• Vestibular nerve section (VNS) treats Meniere's disease when conservative therapies fail.
• Less invasive treatments have reduced VNS frequency.
• The middle cranial fossa (MCF) approach for VNS is technically challenging but offers superior visualization of the internal auditory canal.

Purpose of the Study:

• To demonstrate a step-by-step technique for performing VNS via the MCF approach.
• To highlight advancements that facilitate this uncommon surgical method.
• To showcase successful vestibular nerve sectioning while preserving facial and cochlear nerve function.

Main Methods:

• Utilized the middle cranial fossa approach for vestibular nerve section.
• Incorporated intraoperative facial nerve monitoring with electromyography.
• Employed an ultrasonic bone aspirator for internal auditory canal decompression.

Main Results:

• Successfully sectioned the superior and inferior vestibular nerves.
• Preserved cochlear and facial nerve function throughout the procedure.
• Demonstrated the feasibility of advanced MCF techniques for VNS.

Conclusions:

• The MCF approach, enhanced with modern techniques, provides a viable surgical option for VNS.
• This method allows for precise vestibular nerve sectioning with a low risk of neurological injury.
• It offers a valuable treatment for Meniere's disease refractory to medical management.