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Middle Fossa Vestibular Neurectomy in Retrolabyrinthine Neurectomy Failures
J. Douglas Green, Jr, MD;
Clough Shelton, MD;
Derald E. Brackmann, MD
Arch Otolaryngol Head Neck Surg. 1992;118(10):1058-1060.
Abstract
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• Retrolabyrinthine vestibular nerve section is an important treatment option in patients with refractory, incapacitating vertigo. However, an indistinct cleavage plane between the cochlear and vestibular portions of the eighth cranial nerve may result in incomplete sectioning of the superior and inferior vestibular nerve fibers. We describe 11 patients in whom middle fossa vestibular neurectomy was performed following failure of a retrolabyrinthine vestibular neurectomy. A successful postoperative outcome from this revision surgery was obtained in six of 11 patients on follow-up evaluation. Patients in whom infrared video electronystag-mography showed persistent function of the inferior vestibular nerve following retrolabyrinthine vestibular nerve section had a better response to middle fossa vestibular neurectomy than those with no measurable residual vestibular function. Because it provides access to the vestibular nerves where there is separation from the cochlear nerves distal to the previous section, we feel that the middle fossa vestibular neurectomy is the procedure of choice in selected patients who fail retrolabyrinthine neurectomy.
(Arch Otolaryngol Head Neck Surg. 1992;118:1058-1060)
Author Affiliations
From the Department of Otolaryngology (Dr Green), Mayo Clinic Jacksonville (Fla), and the House Ear Clinic and House Ear Institute, University of Southern California School of Medicine, Los Angeles (Drs Shelton and Brackmann).
Footnotes
Accepted for publication June 2, 1992.
Presented, in part, at the Second Annual Meeting of the North American Skull Base Society, Lake Buena Vista, Fla, March 2, 1991.
Reprint requests to House Ear Clinic, 2100 W Third St, Los Angeles, CA 90057 (Dr Shelton).
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