Bagger-Sjöbäck D
Department of Otolaryngology, Karolinska Sjukhuset, Karolinska Institutet, Stockholm, Sweden.
Acta Otolaryngol Suppl. 1988;455:86-9. doi: 10.3109/00016488809125065.
Surgical therapy for disabling vertigo usually comes in at a late stage in the course of treatment for this patient group. The surgical procedures can be divided into two categories: non-destructive and destructive surgery. The former constitutes primarily procedures directed against the endolymphatic sac such as endolymphatic sac shunt procedures or decompression procedures. Peri-endolymphatic shunt procedures have also been proposed by some surgeons. None of these latter procedures have, however, gained widespread clinical acceptance. Destructive surgery is aimed against the end-organ itself or the vestibular nerve. Labyrinthectomy entails ablation of the vestibular end organs. This procedure is advocated in patients with disabling vertigo and a severe hearing loss or total deafness in the affected ear. Vestibular neurectomy can be performed at different levels. The middle fossa approach allows visualization of the vestibular nerve inside the internal auditory canal, whereas the retrolabyrinthine approach reveals the course of the nerves in the posterior cranial fossa. Vestibular neurectomy offers good results in the hands of a trained otoneurosurgeon.
对于致残性眩晕的手术治疗，通常在该患者群体的治疗过程中处于后期阶段。手术程序可分为两类：非破坏性手术和破坏性手术。前者主要包括针对内淋巴囊的手术，如内淋巴囊分流术或减压术。一些外科医生也提出了内淋巴周围分流术。然而，这些后一种手术都没有获得广泛的临床认可。破坏性手术针对的是终器本身或前庭神经。迷路切除术需要切除前庭终器。该手术适用于患有致残性眩晕且患耳有严重听力损失或全聋的患者。前庭神经切除术可在不同层面进行。中颅窝入路可观察内耳道内的前庭神经，而后迷路后入路则可显示后颅窝内神经的走行。在训练有素的耳神经外科医生手中，前庭神经切除术可取得良好效果。
