Li C-S, Lai J-T
Service of Neurosurgery, Kuang-Tien General Hospital, Taichung, Taiwan.
Acta Neurochir (Wien). 2008 Jul;150(7):655-61; discussion 661. doi: 10.1007/s00701-007-1462-0. Epub 2008 Jun 9.
Retrosigmoid vestibular neurectomy is suggested to be the most effective and safe procedure to control intractable vertigo associated with Ménière's disease. The purpose of this study is to report the excellent efficacy of vertigo control, the good preservation of hearing, the rare complications and the simplicity of retrosigmoid vestibular neurectomy performed by an interdisciplinary team of neurosurgery and otorhinolaryngology experts of our teaching hospital.
Seventy-three patients with Ménière's disease who were refractory to medication or other surgical therapy were consecutively operated on over a period of 7 years. All the patients were referred to the senior author (CSL) for the surgery and were followed-up by the same neurootologist (JTL). The retrosigmoid approach for selective vestibular neurectomy was the only surgical method used in our neurosurgical facility. During surgery the separation line was made just at the cochleo-vestibular cleavage plane on the cochlear nerve to achieve a more complete sectioning of the vestibular fibres. To ensure accurate and complete data collection, patient data was prospectively entered into an electronic database, which was used subsequently for analysis of vertigo control, preservation of hearing, improvement in functional levels, and surgical complications.
Long-term excellent and good vertigo control were achieved in 69 (94.5%) and 4 (5.5%) patients respectively. Hearing was preserved to within 10 dB of the pre-operative pure-tone thresholds in 91.8% of patients at 1 month after the surgery. The functional levels improved to level 1 by a reduction of 3-5 points and became stabilised by 2 years of follow-up in all of our patients. No patient was worse post-operatively. Complications were uncommon and included superficial wound infection and transient partial facial paralysis in one patient each. Total hearing loss did not occur post-operatively. The mean operating time was 70 min.
Selective vestibular neurectomy via the retrosigmoid approach is an effective and simple neurosurgical procedure for the control of intractable vertigo in Ménière's disease while preserving hearing.
乙状窦后前庭神经切断术被认为是控制梅尼埃病相关顽固性眩晕最有效且安全的手术方法。本研究旨在报告我院教学医院神经外科和耳鼻咽喉科专家组成的跨学科团队实施的乙状窦后前庭神经切断术在眩晕控制方面的卓越疗效、听力的良好保留、罕见的并发症以及手术的简便性。
73例对药物治疗或其他手术治疗无效的梅尼埃病患者在7年时间里连续接受了手术。所有患者均由资深作者（CSL）实施手术，并由同一位神经耳科医生（JTL）进行随访。乙状窦后入路选择性前庭神经切断术是我们神经外科唯一使用的手术方法。手术过程中，分离线恰在蜗神经的蜗-前庭分裂平面进行，以实现前庭纤维的更完整切断。为确保准确完整的数据收集，患者数据被前瞻性地录入电子数据库，随后用于分析眩晕控制、听力保留、功能水平改善及手术并发症情况。
分别有69例（94.5%）和4例（5.5%）患者实现了长期的卓越和良好眩晕控制。术后1个月，91.8%的患者听力保留在术前纯音阈值±10dB范围内。所有患者的功能水平通过降低3 - 5分提高到1级，并在随访2年后趋于稳定。术后无患者情况变差。并发症罕见，包括1例浅表伤口感染和1例短暂性部分面瘫。术后未发生全聋。平均手术时间为70分钟。
乙状窦后入路选择性前庭神经切断术是一种有效且简便的神经外科手术，可用于控制梅尼埃病的顽固性眩晕，同时保留听力。
