TRANSTEMPORAL SUPRALABYRINTHINE (MIDDLE CRANIAL FOSSA) VESTIBULAR NEURECTOMY - A REVIEW OF THE LAST 100 CASES

The outcome of 100 consecutive transtemporal supralabyrinthine vestibu lar neurectomies performed between 1982 and 1992 was analyzed retrospe ctively and compared with that of the first 100 operations (1969 to 19 75) in order to analyze the effects of the learning curve on immediate postoperative complications. A total Sensorineural bearing loss, whic h occurred in 2% of the cases initially, could be totally avoided by ( 1) opening the tegmen tympani for better identification of the superio r ampulla and (2) preserving the saccular branch of the inferior divis ion of the vestibular nerve when the identification of the cochlear ne rve was difficult because of a narrow anatomic space. As in the first series of patients, no immediate or delayed total loss of facial funct ion was observed. However, a slightly higher number of delayed, tempor ary facial weaknesses (7% vs 3%) were recorded. The impairment of faci al function was limited mostly to an asymmetric eyelid closure, unnoti ced by the majority of the patients, which disappeared within 10 days. The number of postoperative temporary CSF leaks (through the wound or nose) resolving spontaneously remained the same (12%). There was no i nstance of postoperative meningitis. Due to the minimal dural elevatio n involved in transtemporal: supralabyrinthine vestibular neurectomy, no temporal lobe complications (particularly seizures) have been obser ved. in patients over 65 years of age, the operation lasted, on averag e, 10 minutes longer and the hospitalization was 3 days longer. There was no difference in the duration of the acute subjective vertigo (3 d ays) in patients younger than 65 versus older patients. Transtemporal, supralabyrinthine vestibular neurectomy offers an effective cure for disabling vertigo while preserving hearing in Meniere's disease. The c omplications are acceptable even in patients over 65 years of age if t he operation is carried out with limited elevation of the middle crani al fossa dura by a sufficiently trained and experienced skull base sur geon.