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VESTIBULAR NEURECTOMY IN THE UNITED STATES—1990

Silverstein, Herbert M.D.1,2; Wanamaker, Hayes M.D.1; Flanzer, John M.D.1; Rosenberg, Seth M.D.1

The American Journal of Otology: January 1992 - Volume 13 - Issue 1 - p 23–30
1991 American Otological Society Meeting Papers
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ABSTRACT During the last decade, vestibular neurectomy has become a more frequently performed procedure to cure symptoms of inner ear vertigo while preserving hearing. In an effort to determine the results of vestibular neurectomy across the country, a questionnaire was prepared and sent to the 350 members of the American Otologic Society and the American Neurotology Society. Results of that survey indicated that 2,820 vestibular neurectomy procedures were performed by 58 surgeons. Ninety-two percent (2,590 cases) were performed through the posterior fossa approach. Of these, 1149 cases (44%) were through the retrolabyrinthine approach, 940 cases (36%) were through the retrosigmoid approach, 307 cases (12%) were through the combined retrolabyrinthine-retrosigmoid approach, and 194 cases (8%) were unspecified as to which posterior fossa approach was used. The remaining 230 cases (8%) were through the middle fossa approach. Sectioning of the vestibular nerve was done by the otologist in 58 percent of cases, by the neurosurgeon in 12 percent, and by either surgeon in 30 percent. Classic Meniere's disease, the most common indication for vestibular neurectomy, resulted in the best cure rate of 91 percent. Other inner ear diseases such as traumatic labyrinthitis and vestibular neuronitis had a lower cure rate of 74 to 81 percent. Hearing was preserved to within 20 dB of the preoperative pure-tone thresholds in 87 percent. There were no deaths, 11 cases of meningitis and 16 cases of facial paralysis, 15 of which occurred after middle fossa surgery, representing a 7 percent incidence of facial paralysis after middle fossa surgery. Eleven of the 15 cases resulted in permanent paralysis and four in temporary paralysis. One case of temporary paralysis followed a posterior fossa approach. Thirty-three patients had complete hearing loss, 8 had wound infections, and 26 had cerebral spinal fluid leaks. As their first procedure, endolymphatic sac surgery was recommended by 21 surgeons (36%), and vestibular neurectomy by 14 surgeons (24%); 18 surgeons (31%) use both procedures. The remaining five surgeons (9%) did not respond to this question. Results from this survey indicate that vestibular neurectomy, performed most commonly through a posterior fossa approach (92%), is an effective and safe method for the cure of vertiginous attacks while preserving hearing and has a low incidence of facial paralysis and other complications.

1Ear Research Foundation and Florida Otologic Center, Sarasota, Florida

2Reprint requests: Herbert Silverstein, M.D., Ear Research Foundation, 1901 Floyd Street, Sarasota, FL 34239

Presented at the American Otological Society Meeting, Waikoloa, Hawaii, May 5–6, 1991.

© 1992, The American Journal of Otology, Inc.