Silverstein H, Norrell H, Rosenberg S
Ear Research Foundation, Sarasota, Florida.
J Neurosurg. 1990 Apr;72(4):533-9. doi: 10.3171/jns.1990.72.4.0533.
Between 1925 and 1945, Walter Dandy and Kenneth McKenzie performed more than 700 posterior fossa eighth nerve sections and vestibular neurectomies to treat the intractable vertigo accompanying Ménière's disease. During the past 10 years, with the aid of microsurgical techniques and the approach to the posterior fossa through the temporal bone, vestibular neurectomy has undergone a resurgence of popularity. When hearing is to be preserved, vestibular neurectomy is the surgical treatment of choice for patients who fail to undergo a remission of the vertigo attacks of Ménière's disease. This report reviews 115 consecutive vestibular neurectomies performed from 1978 to 1988 for the treatment of Ménière's disease. In 1978, retrolabyrinthine vestibular neurectomy (RVN), a procedure in which the posterior fossa is entered anterior to the sigmoid sinus and behind the labyrinth, was introduced. During the last 3 years, the approach to the posterior fossa has been a small dural opening behind the sigmoid sinus; this approach is known as the combined retrolabyrinthine retrosigmoid approach. There have been no cases of facial paralysis and no serious complications connected with this technique. A high incidence of headache (50%) resulted when the posterior wall of the internal auditory canal was drilled away for better exposure. Transient cerebrospinal fluid (CSF) leaking occurred in 7% of the patients undergoing RVN; however, no CSF leaks occurred when the combined retrolabyrinthine retrosigmoid approach was used. In the RVN series, wound infection occurred in 20% of the cases until perioperative antibiotics reduced the rate to 3%. The results in terms of curing or improving vertigo have been excellent (94%), and hearing has been preserved to within 20 dB preoperative levels in 76% of the cases. Until a cure for Ménière's disease is found, microsurgical posterior fossa vestibular neurectomy remains the best treatment.
1925年至1945年间，沃尔特·丹迪和肯尼思·麦肯齐实施了700多例后颅窝第八神经切断术和前庭神经切除术，以治疗梅尼埃病伴发的顽固性眩晕。在过去10年里，借助显微外科技术以及经颞骨进入后颅窝的方法，前庭神经切除术再度受到欢迎。当需要保留听力时，对于梅尼埃病眩晕发作未能缓解的患者，前庭神经切除术是首选的外科治疗方法。本报告回顾了1978年至1988年连续实施的115例用于治疗梅尼埃病的前庭神经切除术。1978年，引入了迷路后前庭神经切除术（RVN），该手术是经乙状窦前方、迷路后方进入后颅窝。在过去3年里，进入后颅窝的方法是在乙状窦后方做一个小的硬脑膜开口；这种方法被称为迷路后乙状窦后联合入路。该技术未出现面瘫病例，也没有严重并发症。为了更好地暴露，磨除内耳道后壁时，头痛发生率较高（50%）。接受RVN的患者中有7%出现短暂性脑脊液漏；然而，采用迷路后乙状窦后联合入路时未出现脑脊液漏。在RVN系列中，20%的病例发生伤口感染，直到围手术期使用抗生素后，发生率降至3%。眩晕治愈或改善的效果极佳（94%），76%的病例听力保留在术前水平20分贝以内。在找到治愈梅尼埃病的方法之前，显微外科后颅窝前庭神经切除术仍然是最佳治疗方法。
