ABSTRACT: During the past 15 years, 96 retrosigmoid vestibular neurotomies have been used in the surgical management of incapacitating Meniere's disease for the control of vertigo and preservation of hearing. This posterior approach of the pontocerebellar angle gives the best view on the acousticofacial nerve bundle, through a 2 x 2 cm suboccipital craniotomy immediately behind the mastoid and sigmoid sinus. Then the vestibular nerve is easily identified, separated from the cochlear nerve and sectioned, the facial nerve not being at risk, as it lies much deeper. Actually, the majority of authors agree that vestibular neurotomy is the most effective surgical treatment in relieving disabling vertigo (96% of cases) with serviceable hearing, but few surgeons know that the retrosigmoid approach is simpler and more reliable than the middle fossa or retrolabyrinthine approaches, with a low incidence of complications. The purpose of this paper is to emphasize the routine use of the retrosigmoid approach.
1ENT Department, Hôpital Nord, Marseille, France
2Reprint requests: J. Magnan, ENT Department, Hôpital Nord, 13326 Marseille Cedex 15, France
Editorial Comment. The authors in the above article present an impressive series regarding vestibular nerve section by the retrosigmoid approach. It must be emphasized, however, that this is just one means to a common end. Many neuro-otologic teams would disagree with the author's conclusions regarding the morbidity, complications, and limitations of the middle fossa and retrolabyrinthine approaches. There is no substitute for proper patient selection and experienced, meticulous surgical technique in the performance of vestibular nerve section surgery. If these two issues are properly addressed, the results should be equivalent no matter what approach the surgical team employs.