Selective Vestibular Neurectomy for Intractable Vertigo

Sanjeev Kumar 
 Department of Neurosurgery, DKS Post Graduate Institute and Research Center, Raipur, Chhattisgarh, India

Correspondence Address:
Sanjeev Kumar
Department of Neurosurgery, DKS Post Graduate Institute and Research Center, Raipur, Chhattisgarh
India

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Intractable vertigo is the most disabling symptom of Meniere's disease. The selective vestibular nerve section has shown promising results. After careful evaluation, the vestibular nerve can be sectioned through the retro-mastoid suboccipital approach. In this artistic illustration, the key steps of the surgical procedure are shown. The patient can be positioned lateral or in a park-bench position based on the surgeon's preference. A small craniotomy is made, exposing the transverse and sigmoid sinus. In Figure 1, the red line shows the incision, and the black dotted line shows the craniotomy. The posterior fossa is relaxed by the CSF drainage. A sharp arachnoid dissection exposes the facial-vestibular nerve complex. The vestibular nerve is identified by its posterior superior position and relatively grey colour. Often a tiny vessel separates the vestibular and cochlear nerve, which lies at an inferior position. The use of nerve monitoring for the facial and cochlear nerves is advised. A dissection plain occurs between vestibular and cochlear nerves, which can be developed by a fine dissector. After confirmation of the vestibular nerve, the nerve is divided completely using micro-scissors [Figure 2]. Both cut-ends should be separated well to avoid any future re-anastomosis. The dura should be watertight closed, the bone flap replaced, and the surgical wound should be closed in layers.

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