Vestibular Neurectomy for Intractable Vertigo: Case Series and Evaluation of Role of Endoscopic Assistance in Retrolabyrinthine Craniotomy.

This study evaluates the utility of endoscopy for retrolabyrinthine vestibular nerve section (RLVNS).  This is a retrospective review for RLVNSs by the senior author. The endoscope's utility was assessed and assigned a grade based on operative findings.  Fifteen patients (eight males and seven females; 53 and 47%, respectively) were identified with mean age 56.7 years. Indications included Ménière's disease (MD) in 12 of 15 patients (80%), uncompensated vestibular neuritis in 2 patients (13%), and other vestibular neuropathy in 1 patient (7%). Vertigo resolved in 14 of 15 patients (93%). Complications included decreased hearing in two patients (13%) and deep venous thrombosis in one patient (7%). There were no facial nerve complications or mortalities.  Sectioning vestibular division of the vestibular-cochlear nerve was achieved without perceived benefit of endoscopy in the 80% of cases (grade 0,  = 12). Endoscopy was helpful in patients with a small mastoid (grade 1,  = 2, 13.3%), and deemed necessary where the flocculus of the cerebellum was adherent to the eighth nerve arachnoid at the porus acusticus (grade 2,  = 1, 6.7%).  RLVNS is a safe and efficacious procedure for the treatment of vertigo; the surgical endoscope may be a useful adjunct in selected cases. Patients with MD may expect the greatest benefit from surgery.