What Is A Vestibular Neurectomy?

Reviewed on 1/19/2021

Vestibular Neurectomy

Vestibular neurectomy is one of the surgical treatments for Meniere's disease (dizzy spells with hearing loss).
Vestibular neurectomy is one of the surgical treatments for Meniere's disease (dizzy spells with hearing loss).

Vestibular neurectomy is one of the surgical treatments for Meniere's disease (dizzy spells with hearing loss). The following are the characteristics of the procedure:

  • It is performed to cut off the part of the auditory nerve that helps us maintain our balance. The part of the nerve that preserves the hearing is kept intact.
  • This operation is done to relieve vertigo from the inner ear.
  • The surgery prevents the brain from receiving signals that trigger a vertigo attack. It also initially affects the ability of that ear to regulate balance. Though in a short time, the brain adjusts to using just one ear for balance.
  • This is the last treatment option that is performed if you have good hearing in the affected ear but have not experienced relief from giddiness even after aggressive medical management.

Procedure:

  • The operation is done through the mastoid bone (the bone behind the ear) or by creating an opening in the skull behind the mastoid.
  • The procedure is frequently performed by both a neurologist and neurosurgeon.
  • After the nerves are exposed, the surgeons must use high-powered magnification to identify the separation between the hearing and balancing portions of the eighth cranial nerve. The balance (vestibular) nerve is selectively transacted.
  • In another approach, the surgeon will cut into the dura mater (outermost covering of the brain) and retract the cerebellum (part of the hindbrain situated atop the neck) to reveal the vestibular nerve. The vestibular nerve fibers are carefully cut while leaving the auditory nerve fibers intact.
  • The surgeon will then close the dura mater and incision site.
  • The procedure is usually done under general anesthesia and may take less than 180 minutes depending on the type of approach.

Recovery

Following the surgery, the patient will be moved to an intensive care unit (ICU) directly and monitored. The patient may remain in the hospital for at least 4-7 days to recover. They may experience intense vertigo and loss of balance for a few days after the procedure that requires supportive medical care. The patient may need medications to treat symptoms or a walker to help steady them while walking. They may also be on painkillers and antibiotics for a while. After discharge, the patient may need vestibular and balance therapy to speed the recovery process. Most patients will fully return to their normal function, but they can feel tired, stressed, or imbalanced for a few months.

Risks of the vestibular neurectomy procedure

As with any surgery, there are not only benefits but also risks. A vestibular neurectomy is a complex and relatively risky procedure associated with a variety of complications including:

  • Hearing loss: Mild hearing loss in the operated ear occurs in some patients. In rare cases, total hearing loss occurs.
  • Tinnitus (ringing in ears): Tinnitus may remain, disappear, or get worse.
  • Dizziness: Severe dizziness, vertigo, and imbalance are common immediately following surgery due to cutting of the balance nerve. After a few days, vertigo spinning stops, and imbalance improves slowly over weeks to months. In a few patients, a permanent imbalance may be a result. Even after a year, a slight transient imbalance may occur, which does not usually interfere with normal activities.
  • Facial weakness: The facial nerve is situated quite close to the balance and hearing nerves. A weakness of the face from injury to the facial nerve is a rare complication of surgery. A facial weakness has occurred temporarily in very few patients. It is important to understand that there is an inherent risk of cutting the facial nerve because this nerve is also in the same place as the hearing and balance nerves.
  • Spinal fluid leak: Rarely, persistent cerebrospinal fluid (brain fluid) leaks from the wound. The patient must remain in the hospital with the spinal fluid drain in place for 3 or 4 days until the leak stops. Rarely, further surgery is necessary.
  • Infection: Serious infection rarely occurs following surgery. If it develops, it could lead to meningitis, which an infection in the fluid and tissues surrounding the brain. This requires prolonged hospital treatment with antibiotics. A wound infection occurs in a few cases and is treated with antibiotics and drainage; this is usually not a serious problem.
  • Surgical and anesthesia-related complications, such as pain and constipation, may be manageable with medications.

The outcome of the vestibular neurectomy procedure:

  • This procedure is offered to patients who are younger than 60 years and in good health. It is one of the best options to cure vertigo from Meniere’s disease that does not respond to medicines. Vestibular neurectomy is considered the reference treatment for incapacitating vertigo accompanying Meniere’s disease with an efficiency rate of 85-95% in most literature reports. Up to 95% of vestibular neurectomies cure vertigo.
  • Very few complain or notice additional postoperative hearing loss. Generally, patients are happy to be free of vertigo attacks. The tinnitus and pressure may continue, but they do not pose significant problems. Most patients resume a normal lifestyle.

Overall, vestibular neurectomy is relatively safe and is a highly effective procedure. The surgery has a low incidence of complications and a high rate of success (93%) in curing vertigo attacks.

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References
Poduval J. Vestibular Neurectomy. Medscape. https://emedicine.medscape.com/article/2051885-overview

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