Selective Vestibular Neurectomy for Refractory Meniere’s Disease: Our Experience with the Presigmoid Retrolabyrinthine Approach

Background: Refractory Meniere’s disease (MD) is a disabling disease; moreover, selective vestibular neurectomy (VN), in these selected cases of drug-resistant pathology, can be considered an alternative surgical option in order to preserve hearing and facial nerve function.

Methods: We retrospectively studied 30 patients with refractory MD diagnosis; an additional inclusion criteria were the failure of extradural endolymphatic sac surgery (ELSS). All patients underwent combined microendoscopic selective VN, between January 2019 and May 2024, via a presigmoid retrolabyrinthine approach and were classified according to clinical features and assessed pre- and postoperative hearing and quality of life.

Results: Ninety percent vertigo control after surgery was obtained with a maximum present follow-up of 2 years; a low rate of complications around 1 to 2% was registred. No definitive facial palsy or hearing loss was described in this series and two patients required reintervention for a CSF fistula. Statistically significant (p = 0.001) difference was found between the preoperative and the postoperative performance in terms of physical, functional, and emotive scales assessed via the DHI questionnaire.

Conclusion: Intractable vertigo associated with MD is potentially safely eligble for selective VN via a presigmoid retrolabyrinthine approach; residual hearing function should be verified preoperatively. A tailored use of the endoscope and intraoperative neuromonitoring guaranteed the preservation of the cochlear and facial fibers with an overall precise result. As a multidisciplinary team we believe that this approach for VN combines the expertise of the otolaryngologist and the neurosurgeon in terms of lateral skull base anatomy and handling its related disorders; thus, in our opinion, best results are obtained together.

Publication History

Article published online:
07 February 2025