Yu Tian, Chen Xiaohong
University Master Degree Cultivation Base, Zhejiang Chinese Medical University, Zhejiang, 310053, China.
The Second Hospital of Jiaxing, Zhejiang, 314000, China.
Eur Arch Otorhinolaryngol. 2025 May 23. doi: 10.1007/s00405-025-09467-w.
To provide a comprehensive review of surgical strategies for vestibular dysfunction-induced vertigo (VDIV), including indications, contraindications, and comparative efficacy analyses of mainstream procedures, and to critically evaluate contemporary controversies and emerging directions based on recent advancements.
Vestibular dysfunction-induced vertigo (VDIV), a balance disorder caused by inner ear pathology, significantly impacts patients' quality of life and often requires surgical intervention when conservative treatments fail. While pharmacological management and vestibular rehabilitation alleviate symptoms in most cases, approximately 10-20% of patients progress to refractory VDIV due to failed conservative treatment, necessitating surgical intervention.
This article provides a comprehensive review of surgical strategies for VDIV, including indications, contraindications, and comparative efficacy analyses of mainstream procedures (e.g., endolymphatic sac decompression, semicircular canal occlusion, vestibular neurectomy).
Current evidence suggests that ESD offers symptom control in 62.1%-80.36% of patients with minimal invasiveness, while transcanal semicircular canal plugging (TSCP) achieves higher success rates (96.7%-100%) at the cost of potential hearing loss. For patients in the advanced stage of the disease, combined surgical procedures (such as ESD+TSCP) can achieve a balance between vertigo control (100%) and hearing preservation (with a hearing loss rate of 33.3%). CONCLUSION: The selection of surgical methods should be based on a comprehensive consideration of the patient's specific condition, including the severity of vertigo, hearing level, and overall health status. Future research should focus on exploring more effective and less invasive surgical techniques to improve the prognosis of patients. Additionally, in-depth studies on the long-term outcomes and quality of life of patients after different surgical procedures are necessary to provide more scientific and reliable evidence for clinical decision making.
全面综述前庭功能障碍性眩晕（VDIV）的手术策略，包括适应症、禁忌症以及主流手术的疗效对比分析，并基于近期进展对当代争议和新方向进行批判性评估。
前庭功能障碍性眩晕（VDIV）是一种由内耳病变引起的平衡障碍，严重影响患者的生活质量，保守治疗失败时通常需要手术干预。虽然药物治疗和前庭康复在大多数情况下可缓解症状，但约10%-20%的患者因保守治疗失败而进展为顽固性VDIV，需要手术干预。
本文全面综述了VDIV的手术策略，包括适应症、禁忌症以及主流手术（如内淋巴囊减压术、半规管阻塞术、前庭神经切除术）的疗效对比分析。
目前证据表明，内淋巴囊减压术（ESD）在62.1%-80.36%的患者中可实现症状控制，且侵袭性最小，而经耳道半规管堵塞术（TSCP）成功率更高（96.7%-100%），但可能以听力损失为代价。对于疾病晚期患者，联合手术（如ESD+TSCP）可在眩晕控制（100%）和听力保留（听力损失率为33.3%）之间取得平衡。
手术方法的选择应综合考虑患者的具体情况，包括眩晕严重程度、听力水平和整体健康状况。未来研究应专注于探索更有效、侵袭性更小的手术技术，以改善患者预后。此外，有必要对不同手术后患者的长期结局和生活质量进行深入研究，为临床决策提供更科学可靠的证据。
