In some patients with medically refractory recurrent vertigo, ablative therapies that destroy labyrinthine function, such as intratympanic gentamicin, vestibular neurectomy
, and surgical labyrinthectomy, are effective at reducing episodes of vertigo, but with either sacrifice or risk to residual hearing and any remaining vestibular function in the treated ear.
The doctor may remove some of the bone around the inner ear (endolymphatic sac decompression), drain the inner ear fluid through a tube (endolymphatic shunt), cutting the nerve for balance (vestibular neurectomy
) and the ultimate removing the inner ear (labyrinthectomy).
In patients who have a complete unilateral vestibular loss secondary to vestibular neurectomy
or labyrinthectomy, the reported sensitivity and specificity of the HIT both reached the area of 100% when the ENG/VNG caloric test results were used as a reference.
Of note, Lacour and colleagues  observed an accelerated recovery of synaptic density in the medial vestibular nuclei of EGb 761treated cats after unilateral vestibular neurectomy
In another more reliable operation, a vestibular neurectomy
, the vestibular nerve which serves balance is severed so that it no longer sends distorted messages to the brain.
Selective vestibular neurectomy
is a procedure in which the balance nerve is cut as it leaves the inner ear and goes to the brain.
During vestibular neurectomy
and neurovascular conflict syndrome surgery, the surgeon can comfortably use both hands to drill the fundus with the help of the endoscope cannula, and maneuverability would also increase because the endoscope can be stabilized at any point.
The 20 patients with recurrence required additional gentamicin injections, plus vestibular neurectomy
in 2 of them and transmastoid labyrinthectomy for persistent vertigo attacks in 1.
Among the treatment techniques the only methods for MD that have gained high evidence are labyrinthectomy and vestibular neurectomy
. Among these two, vestibular neurectomy
is a selective technique issued to superior and inferior vestibular nerves and keeping the cochlear nerve safe.
The success of posterior approaches to both vestibular neurectomy
and hearing-preservation acoustic neuroma surgery has decreased the frequency with which middle fossa procedures are performed for these indications.
For that matter, I am not aware of a single "neurotologist" in the United States whose career is solely dedicated to diagnosis and surgical treatment of intracranial diseases (acoustic tumors, vestibular neurectomy
Human ocular torsional position before and after unilateral vestibular neurectomy
. Exp Brain Res 1991;85:218-25.