A century of eighth nerve surgery

Study Design: A scholarly review of over 70 original papers from the late 1 9th and early 20th centuries. Results: Although many neurotologists consider vestibular nerve section to be a recent innovation, eighth nerve division dates back to the dawn of int racranial surgery. Although surgery of peripheral nerves (e.g., repair afte r injury) is ancient, intracranial nerve surgery began in the latter part o f the 19th century with fifth nerve division for tic douloureux. By analogy , it was reasoned that hyperactivity of the eighth nerve (initially tinnitu s and later vertigo) could be relieved by dividing this nerve. In 1898, Fed or Krause (1856-1937) of Berlin attempted the first eighth nerve section. T his patient, as did many during this era, died shortly after the operation. Most of the survivors had facial palsy. These innovative early surgeons us ed a variety of approaches, including the suboccipital. middle fossa, and t ranstemporal routes. After an initial burst of excitement during the first decade of the century, poor results led to Few procedures being performed t hrough the second and third decades. Throughout this era, there was much de bate about the relative merits of labyrinthectomy (introduced by Milligan a nd Lake in 1904) as opposed to eighth nerve division. In the late 1920s, th e prolific Waiter E. Dandy (1886-1946) of Baltimore repopularized eighth ne rve section and ultimately performed 607 procedures between 1927 and 1946. Although Dandy achieved a high vertigo control rate and reduced the mortali ty rate to <1%, he had a high rate of facial nerve weakness (9.1% transient , 4.2% permanent). Remarkably, the latter outcome was never published in hi s numerous papers on the subject, but was first revealed in a 1951 retrospe ctive survey, which appeared some 5 years after his death. Selective divisi on of the vestibular Fibers was introduced by Kenneth G. McKenzie (1892-196 3) of Toronto in 1931. At least 11 sizable series appeared in the literatur e before the introduction of microsurgical vestibular nerve section by Will iam F. House (b. 1923) of Los Angeles in 1960. Conclusions: The introduction and progressive refinement of eighth nerve se ction played a central role in the evolution of operative neurotology. Many of the most vigorous debates of recent years (e.g., the choice of operativ e route, the optimal site of division, and the relative role of inner ear s urgery vs. nerve surgery) have antecedents in the controversies of the dist ant past.