The surgical treatment of vertigo. The essentials of patient selection and long-term results.

The essential features of the posturing and positional mechanisms in man are defined and the causes of their dysfunction categorized to provide a scheme of surgical management appropriate for each. The authors' long-term results (two to twelve years) with (1) twenty-seven operations designed to decompress the endolymphatic system, (2) twenty-eight selective eighth nerve sections are documented and compared, by means of statistical analysis, with those reported by others during the past fifteen years. Although the latter procedure provided better control of vertigo, there was no difference between the two groups in regard to preservation of hearing. Nor was there any evidence from this study that either operation did anything to alter the progressive hearing loss that characterizes Meniere's disease. Nevertheless, because of failure of noninvasive therapy to control vertiginous symptoms in some patients, it would appear that there is still a definite place for surgical treatment. Saccus decompression is recommended as the initial procedure because it is technically less difficult. In patients whose vertigo persists in conjunction with useful auditory function vestibular nerve section should be considered before resorting to total labyrinthectomy.