Download PDF
CC BY-NC-ND 4.0 · Int Arch Otorhinolaryngol 2017; 21(02): 184-190
DOI: 10.1055/s-0037-1599242
Systematic Review – The Surgical Management of Vestibular Disorders
Thieme-Revinter Publicações Ltda Rio de Janeiro, Brazil

Labyrinthectomy and Vestibular Neurectomy for Intractable Vertiginous Symptoms

Alfredo Vega Alarcón
1   Neurology Center, Centro Médico American British Cowdray, México, DF, Mexico
2   Otorhinolaryngology and Neurotology Department, Instituto Nacional de Neurología y Neurocirugía Dr. Manuel Velasco Suárez, México, DF, Mexico
,
Lourdes Olivia Vales Hidalgo
2   Otorhinolaryngology and Neurotology Department, Instituto Nacional de Neurología y Neurocirugía Dr. Manuel Velasco Suárez, México, DF, Mexico
,
Rodrigo Jácome Arévalo
2   Otorhinolaryngology and Neurotology Department, Instituto Nacional de Neurología y Neurocirugía Dr. Manuel Velasco Suárez, México, DF, Mexico
,
Marite Palma Diaz
1   Neurology Center, Centro Médico American British Cowdray, México, DF, Mexico
2   Otorhinolaryngology and Neurotology Department, Instituto Nacional de Neurología y Neurocirugía Dr. Manuel Velasco Suárez, México, DF, Mexico
› Author Affiliations
Further Information

Publication History

02 December 2016

01 February 2017

Publication Date:
31 March 2017 (online)

   Permissions and Reprints

Abstract

Introduction Labyrinthectomy and vestibular neurectomy are considered the surgical procedures with the highest possibility of controlling medically untreatable incapacitating vertigo. Ironically, after 100 years of the introduction of both transmastoid labyrinthectomy and vestibular neurectomy, the choice of which procedure to use rests primarily on the evaluation of the hearing and of the surgical morbidity.

Objective To review surgical labyrinthectomy and vestibular neurectomy for the treatment of incapacitating vestibular disorders.

Data Sources PubMed, MD consult and Ovid-SP databases.

Data Synthesis In this review we describe and compare surgical labyrinthectomy and vestibular neurectomy. A contrast between surgical and chemical labyrinthectomy is also examined. Proper candidate selection, success in vertigo control and complication rates are discussed on the basis of a literature review.

Conclusions Vestibular nerve section and labyrinthectomy achieve high and comparable rates of vertigo control. Even though vestibular neurectomy is considered a hearing sparing surgery, since it is an intradural procedure, it carries a greater risk of complications than transmastoid labyrinthectomy. Furthermore, since many patients whose hearing is preserved with vestibular nerve section may ultimately lose that hearing, the long-term value of hearing preservation is not well established. Although the combination of both procedures, in the form of a translabyrinthine vestibular nerve section, is the most certain way to ablate vestibular function for patients with no useful hearing and disabling vertigo, some advocate for transmastoid labyrinthectomy alone, considering that avoiding opening the subarachnoid space minimizes the possible intracranial complications. Chemical labyrinthectomy may be considered a safer alternative, but the risks of hearing loss when hearing preservation is desired are also high.

Keywords

vestibular diseases/surgery - labyrinth diseases/surgery - Ménière's disease/surgery - neuritis/surgery - vertigo/surgery - vestibular nerve/surgery - vestibulocochlear nerve diseases/surgery
 

  • References

  • 1 Jackler RK, Whinney D. A century of eighth nerve surgery. Otol Neurotol 2001; 22 (03) 401-416
    CrossrefPubMedGoogle Scholar
  • 2 Molony TB. Decision making in vestibular neurectomy. Am J Otol 1996; 17 (03) 421-424
    Google Scholar
  • 3 Silverstein H, Norrell H, Smouha E, Jones R. Combined retrolab-retrosigmoid vestibular neurectomy. An evolution in approach. Am J Otol 1989; 10 (03) 166-169
    Google Scholar
  • 4 Silverstein H, Wanamaker H, Flanzer J, Rosenberg S. Vestibular neurectomy in the United States--1990. Am J Otol 1992; 13 (01) 23-30
    CrossrefPubMedGoogle Scholar
  • 5 Quaranta A, Onofri M, Sallustio V, Iurato S. Comparison of long-term hearing results after vestibular neurectomy, endolymphatic mastoid shunt, and medical therapy. Am J Otol 1997; 18 (04) 444-448
    Google Scholar
  • 6 Schlegel M, Vibert D, Ott SR, Häusler R, Caversaccio MD. Functional results and quality of life after retrosigmoid vestibular neurectomy in patients with Ménière's disease. Otol Neurotol 2012; 33 (08) 1380-1385
    CrossrefPubMedGoogle Scholar
  • 7 Lehnen N, Aw ST, Todd MJ, Halmagyi GM. Head impulse test reveals residual semicircular canal function after vestibular neurectomy. Neurology 2004; 62 (12) 2294-2296
    CrossrefPubMedGoogle Scholar
  • 8 Sargent EW, Liao E, Gonda Jr RL. Cochlear patency after transmastoid labyrinthectomy for Ménière's syndrome. Otol Neurotol 2016; 37 (07) 937-939
    CrossrefPubMedGoogle Scholar
  • 9 Heidenreich KD, Griffin GR, Lorenz MB, Telian SA. Transmastoid labyrinthectomy for disabling vertigo in a patient with internal auditory canal pathology. Otol Neurotol 2011; 32 (01) 122-124
    CrossrefPubMedGoogle Scholar
  • 10 Committee on Hearing and Equilibrium guidelines for the diagnosis and evaluation of therapy in Menière's disease. American Academy of Otolaryngology-Head and Neck Foundation, Inc. Otolaryngol Head Neck Surg 1995; 113 (03) 181-185
    CrossrefPubMedGoogle Scholar
  • 11 Diaz RC, LaRouere MJ, Bojrab DI, Zappia JJ, Sargent EW, Shaia WT. Quality-of-life assessment of Ménière's disease patients after surgical labyrinthectomy. Otol Neurotol 2007; 28 (01) 74-86
    CrossrefPubMedGoogle Scholar
  • 12 Badke MB, Pyle GM, Shea T, Miedaner J. Outcomes in vestibular ablative procedures. Otol Neurotol 2002; 23 (04) 504-509
    CrossrefPubMedGoogle Scholar
  • 13 Eisenman DJ, Speers R, Telian SA. Labyrinthectomy versus vestibular neurectomy: long-term physiologic and clinical outcomes. Otol Neurotol 2001; 22 (04) 539-548
    CrossrefPubMedGoogle Scholar
  • 14 De La Cruz A, Borne Teufert K, Berliner KI. Transmastoid labyrinthectomy versus translabyrinthine vestibular nerve section: does cutting the vestibular nerve make a difference in outcome?. Otol Neurotol 2007; 28 (06) 801-808
    CrossrefPubMedGoogle Scholar
  • 15 Hoffmann KK, Silverstein H. Inner ear perfusion: indications and applications. Curr Opin Otolaryngol Head Neck Surg 2003; 11 (05) 334-339
    CrossrefPubMedGoogle Scholar
  • 16 Beck C, Schmidt CL. 10 years of experience with intratympanally applied streptomycin (gentamycin) in the therapy of Morbus Menière. Arch Otorhinolaryngol 1978; 221 (02) 149-152
    CrossrefPubMedGoogle Scholar
  • 17 Horii A, Saika T, Uno A. , et al. Factors relating to the vertigo control and hearing changes following intratympanic gentamicin for intractable Ménière's disease. Otol Neurotol 2006; 27 (06) 896-900
    CrossrefPubMedGoogle Scholar
  • 18 Colletti V, Carner M, Colletti L. Auditory results after vestibular nerve section and intratympanic gentamicin for Ménière's disease. Otol Neurotol 2007; 28 (02) 145-151
    CrossrefPubMedGoogle Scholar