Between 1925 and 1945, Walter Dandy and Kenneth McKenzie performed more than 700 posterior fossa eighth nerve sections and vestibular
neurectomies, treating the intractable
vertigo accompanying
Meniere's disease. During the past 10 years, using microsurgical techniques and reaching the posterior fossa through the temporal bone, vestibular
neurectomy has enjoyed a resurgence of popularity. When hearing is to be preserved, vestibular
neurectomy is the surgical treatment of choice, if the patient fails to undergo a remission of the
vertigo of
Meniere's disease. This report reviews 115 consecutive vestibular
neurectomies performed for the treatment of
Meniere's disease from 1978 to 1988.In 1978, the retrolabyrinthine vestibular
neurectomy (RVN) was introduced, a procedure in which the posterior fossa is entered anterior to the sigmoid sinus and behind the labyrinth. During the last three years, the approach to the posterior fossa has been a small dural opening behind the sigmoid sinus, the combined retrolabyrinthine-retrosigmoid (R-R) approach. There have been no cases of
facial paralysis and no serious complications. A high incidence of
headache (75%) resulted when the posterior wall of the internal auditory canal was drilled away for better exposure. Transient cerebrospinal fluid (CSF) leaks occurred in 7% of the patients having the RVN, the incidence was 3% when the combined R-R approach was used. In the RVN series,
wound infection occurred in 20% of cases until perioperative
antibiotics reduced the rate to 3%. The results in curing or improving
vertigo have been excellent (94%), and hearing has been preserved to within 20 dB of the preoperative levels in 76%. Until a cure for
Meniere's disease is found, microsurgical posterior fossa vestibular
neurectomy remains the best treatment.