Pappas D G, Pappas D G
Pappas Ear Clinic, Birmingham, Alabama 35233, U.S.A.
Laryngoscope. 1997 Sep;107(9):1203-9. doi: 10.1097/00005537-199709000-00009.
Vestibular nerve section is considered an effective modality in the treatment of refractory and incapacitating vertigo. Typically nerve section results are described on the basis of short-term follow-up. We have reviewed 41 cases of vestibular nerve section spanning an 18-year period. Although the majority of cases involved classic Meniere's disease, delayed endolymphatic hydrops, vestibular neuritis, and Meniere's syndrome secondary to head trauma were also included. Surgical approaches included translabyrinthine (20 cases), retrolabyrinthine (14 cases), retrosigmoid (six cases), and middle fossa (one case) procedures. Postoperative follow-up time averaged 102 months, with 46% of patients followed for a minimum of 9 years. Results are reported according to standards set forth by the American Academy of Otolaryngology--Head and Neck Surgery. Vertigo was cured or markedly improved in 88% of cases (90% in patients with Meniere's disease) at 18 to 24 months postoperatively. These vertigo results were sustained at the time of latest follow-up. Functional level was also preserved over time despite the development of bilateral symptoms in several cases. The rate of bilateral disease reached 22% of cases. Although vertigo results remained stable, long-term follow-up of successful hearing preservation cases demonstrated deterioration over time. Postoperative continuation of medical treatment is urged to optimize and sustain the vestibular neurectomy result.
前庭神经切断术被认为是治疗难治性和致残性眩晕的一种有效方法。通常，神经切断术的结果是基于短期随访来描述的。我们回顾了18年间41例前庭神经切断术病例。虽然大多数病例涉及典型的梅尼埃病，但也包括迟发性内淋巴积水、前庭神经炎以及头部外伤继发的梅尼埃综合征。手术方法包括经迷路（20例）、迷路后（14例）、乙状窦后（6例）和中颅窝（1例）手术。术后平均随访时间为102个月，46%的患者至少随访了9年。结果根据美国耳鼻咽喉头颈外科学会制定的标准报告。术后18至24个月时，88%的病例眩晕得到治愈或明显改善（梅尼埃病患者中为90%）。这些眩晕结果在最近一次随访时得以维持。尽管有几例出现了双侧症状，但随着时间的推移，功能水平也得以保留。双侧疾病的发生率达到了22%。虽然眩晕结果保持稳定，但成功保留听力病例的长期随访显示，随着时间的推移听力出现了恶化。建议术后继续进行药物治疗，以优化并维持前庭神经切除术的效果。
