Fully Endoscopic Retrosigmoid Vestibular Nerve Section
for Refractory Meniere Disease.
[18,19] When intense attacks are frequent, more invasive procedures such as instillation of gentamicin or steroids via intratympanic injection or a grommet may be considered or, very rarely, vestibular nerve section
Another procedure, vestibular nerve section
, involves cutting the vestibular nerve that connects balance and movement sensors in the inner ear to the brain.
Transmastoid labyrinthectomy versus translabyrinthine vestibular nerve section
: does cutting the vestibular nerve make a difference in outcome?
Vestibular nerve section
versus intratympanic gentamicin for Meniere's disease.
Cass et al evaluated 24 patients who underwent posterior fossa vestibular nerve section
for intractable vertigo caused by Meniere's disease, benign paroxysmal positional vertigo, vestibular neuritis, or perilymph fistula.
On imaging studies, each patient had a different pathologic lesion that involved the endolymphatic sac or duct: patient 1 had a jugular megabulb, and she was ultimately treated with vestibular nerve section
; patient 2 had a cholesterol granuloma, which was treated with surgical excision; patient 3 had an endolymphatic sac tumor that was treated with surgical excision.
But for patients who still maintain functional hearing, vestibular nerve section
, endolymphatic sac surgery, and intratympanic aminoglycoside therapy should be considered.
The chances of achieving long-term vertigo control are greater with vestibular nerve section
than with ELS surgery.
Ablative procedures include labyrinthectomy, vestibular nerve section
, streptomycin perfusion of the labyrinth, and gentamicin or streptomycin instillation into the middle ear.
To summarize, they are the use of the operating microscope, tympanoplasty and mastoidectomy techniques, stapes surgery, endolymphatic sac surgery for intractable Meniere's disease, skull base surgery (for example, removal of vestibular schwannomas, vestibular nerve sections
), use of intratympanic gentamycin, and cochlear implantation, not to mention the discovery of new diseases.
It encompasses procedures in the posterior fossa, such as acoustic neuromas, meningiomas, epidermoid tumors, vestibular nerve sections
, and diseases of the petrous apex.