Surgical treatment of vertigo.

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.