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2017 ; 21
(2
): 184-190
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Labyrinthectomy and Vestibular Neurectomy for Intractable Vertiginous Symptoms
#MMPMID28382129
Alarcón AV
; Hidalgo LO
; Arévalo RJ
; Diaz MP
Int Arch Otorhinolaryngol
2017[Apr]; 21
(2
): 184-190
PMID28382129
show ga
Introduction?Labyrinthectomy and vestibular neurectomy are considered the
surgical procedures with the highest possibility of controlling medically
untreatable incapacitating vertigo. Ironically, after 100 years of the
introduction of both transmastoid labyrinthectomy and vestibular neurectomy, the
choice of which procedure to use rests primarily on the evaluation of the hearing
and of the surgical morbidity. Objective?To review surgical labyrinthectomy and
vestibular neurectomy for the treatment of incapacitating vestibular disorders.
Data Sources?PubMed, MD consult and Ovid-SP databases. Data Synthesis?In this
review we describe and compare surgical labyrinthectomy and vestibular
neurectomy. A contrast between surgical and chemical labyrinthectomy is also
examined. Proper candidate selection, success in vertigo control and complication
rates are discussed on the basis of a literature review. Conclusions?Vestibular
nerve section and labyrinthectomy achieve high and comparable rates of vertigo
control. Even though vestibular neurectomy is considered a hearing sparing
surgery, since it is an intradural procedure, it carries a greater risk of
complications than transmastoid labyrinthectomy. Furthermore, since many patients
whose hearing is preserved with vestibular nerve section may ultimately lose that
hearing, the long-term value of hearing preservation is not well established.
Although the combination of both procedures, in the form of a translabyrinthine
vestibular nerve section, is the most certain way to ablate vestibular function
for patients with no useful hearing and disabling vertigo, some advocate for
transmastoid labyrinthectomy alone, considering that avoiding opening the
subarachnoid space minimizes the possible intracranial complications. Chemical
labyrinthectomy may be considered a safer alternative, but the risks of hearing
loss when hearing preservation is desired are also high.
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