[Vestibular neurotomy by the posterior retrosinus approach. Technics, results and indications]

A posterior retrosinus approach was used for 50 vestibular neurotomies to treat patients with severe "Ménière's" disease. The pontocerebellar angle is approached by trephination of a 2 cm diameter opening immediately behind the mastoid and lateral sinus. The acoustic-facial nerve bundle lies 55 mm deep to the craniotomy opening. The vestibular nerve is separated from the cochlear and sectioned, the facial nerve not being at risk as it lies much deeper. Results after a minimum follow up of one year showed recovery from vertigo in 96 p. 100 of cases. Deafness, which was unchanged following surgery, did not appear to progress in most cases. Tinnitus was unchanged. Facial nerve lesions were never observed. The operation is a simple one (duration of 90 minutes) and is reliable, and vestibular neurotomy by the pontocerebellar angle approach appears to be most effective currently available method for treating severe cases of "Ménière's" disease. Decompression procedures provide results that are too inconstant, while neurectomy by a suprapetrous approach is a much riskier op eration than that which uses a posterior approach as described above.