VIDEO ENDOSCOPY-ASSISTED VESTIBULAR NEURECTOMY - A NEW APPROACH TO THE 8TH-CRANIAL NERVE

Disequilibrium, ranging from lightheadedness to severe vertigo, is fre quently of great concern to the patients with a variety of inner ear d iseases, and may cause occupational and social disability. Vestibular nerve section may be considered when vestibular symptoms are resistant to medical therapy and associated with serviceable hearing in the inv olved ear. During the last century, numerous authors described several routes for intracranial section of the eighth nerve, such as lateral suboccipital craniotomy, middle cranial fossa approach, and retrolabyr inthine approach to the vestibular fossa. Control of vertigo by all ro utes to the vestibular nerve has a success rate of 80% to 90%. The pot ential for endoscopic approach to intracranial cavities was recognized early in this century but, due to technical limitations, was largely abandoned after a few attempts. Advances in optics, and the introducti on of very fine instruments made endoscopy worth reconsideration. Sinc e the early 1980s, rigid endoscopes have been used in otorhinolaryngol ogy for paranasal sinus surgery and the visualization of the facial an d vestibulocochlear nerves during acoustic tumor surgery. We performed endoscopic section of the vestibular nerve through a retrolabyrinthin e approach in two cadavers and in two patients with the symptoms of di sequilibrium. In the literature survey, we could find no reports on ve stibular neurectomy performed by endoscopic technique. We describe tec hnical details of the approach, and conclude that the technique is saf e and effective.