Vestibular nerve section via retrolabyrinthine craniotomy

Publication date: Available online 20 August 2019Source: Operative Techniques in Otolaryngology-Head and Neck SurgeryAuthor(s): Zachary R. Barnard, Gregory P. Lekovic, Eric P. Wilkinson, Kevin A. PengMeniere's disease can cause debilitating dizziness and vertigo despite maximal medical management. In select patients, treatment with vestibular nerve section provides optimal outcomes for symptom control and hearing preservation. Vestibular nerve section is also indicated in other vestibular disorders, including refractory uncompensated vestibular neuritis. Surgical approaches for vestibular nerve section include the retrolabyrinthine, retrosigmoid, middle fossa, and translabyrinthine craniotomies. The advantages of the retrolabyrinthine approach include rapid access, excellent visualization of the facial and cochlear nerves, and the possibility of hearing preservation in conjunction with consistent outcomes for vestibular symptoms. In this chapter, we discuss the retrolabyrinthine approach for vestibular nerve section, providing the reader with an overview of when, why, and how to employ the technique.
Source: Operative Techniques in Otolaryngology Head and Neck Surgery - Category: ENT & OMF Source Type: research

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CONCLUSIONS: The authors found that superior semicircular canal dehiscence patients who undergo sealing without plugging have improved balance outcomes but show more tinnitus postoperatively than patients who undergo plugging. PMID: 31252395 [PubMed - as supplied by publisher]
Source: Journal of Neurosurgery - Category: Neurosurgery Authors: Tags: J Neurosurg Source Type: research
Authors: Weinreich HM, Carey JP Abstract Perilymphatic fistulas (PLF) and superior semi-circular canal dehiscence syndrome (SCDS) are 2 conditions that can present with sound and/or pressure-induced vertigo. PLF should be suspected in cases of trauma or surgery, while a spontaneous PLF is a diagnosis of exclusion. Research is ongoing to identify an ideal biomarker for perilymph. The diagnosis of SCDS continues to evolve with further research into vestibular-evoked myogenic potentials, electrocochleography, and higher resolution CT imaging. Treatment advances include the transmastoid approach, smaller middle fossa c...
Source: Advances in Oto-Rhino-Laryngology - Category: ENT & OMF Tags: Adv Otorhinolaryngol Source Type: research
J Neurol Surg B DOI: 10.1055/s-0038-1676840A 36-year-old lady presented with tinnitus and hearing loss for 1 year which was progressively worsening. A hearing test revealed pure tone average (PTA) between 48 to 65 dB and speech discrimination of 56% at 95 dB. Brain magnetic resonance imaging (MRI) showed a right vestibular schwannoma 5 × 8 mm (Fig. 1) which extended far laterally to the fundus of internal auditory canal (IAC). A translabyrinthine approach was suggested by another neurosurgeon/neurotologist team, but the patient decided to undergo operation by retrosigmoid approach w...
Source: Journal of Neurological Surgery Part B: Skull Base - Category: Neurosurgery Authors: Tags: Skull Base: Operative Videos Source Type: research
Conclusion RLVNS is a safe and efficacious procedure for the treatment of vertigo; the surgical endoscope may be a useful adjunct in selected cases. Patients with MD may expect the greatest benefit from surgery. [...] Georg Thieme Verlag KG Stuttgart · New YorkArticle in Thieme eJournals: Table of contents  |  Abstract  |  Full text
Source: Journal of Neurological Surgery Part B: Skull Base - Category: Neurosurgery Authors: Tags: Original Article Source Type: research
J Neurol Surg B DOI: 10.1055/s-0038-1669974The case described in this video involved a 38-year-old man, who presented with a 4-week history of worsening acute-onset headache, nausea, double vision, and vertigo. On examination, he had impaired tandem gait and diplopia on right horizontal gaze. A computed tomography (CT) scan revealed a hyperdense lesion of the right cerebellopontine angle. Magnetic resonance imaging (MRI) revealed a nonenhancing middle cerebellar peduncle lesion that was isointense on T2-weighed imaging and hypointense on FLAIR imaging (Fig. 1A–B). The differential diagnoses for this lesion included c...
Source: Journal of Neurological Surgery Part B: Skull Base - Category: Neurosurgery Authors: Tags: Skull Base: Operative Videos Source Type: research
J Neurol Surg B DOI: 10.1055/s-0038-1669980This video illustrates the case of a 51-year-old woman who presented with sudden-onset headache, vertigo, and nausea. Imaging revealed an epidermoid cyst of the posterior fossa with mass effect upon the brainstem and displacement of the basilar artery. This lesion was approached using a left-sided keyhole retrosigmoid craniotomy with monitoring of the cranial nerves. This video illustrates the technique of internal debulking of the cyst contents with minimal manipulation of the cyst capsule, which is often densely adherent to the brainstem, cranial nerves, and vessels in the poste...
Source: Journal of Neurological Surgery Part B: Skull Base - Category: Neurosurgery Authors: Tags: Skull Base: Operative Videos Source Type: research
ConclusionA transcanal, infracochlear approach to the IAC may permit a minimally invasive approach to distal vestibular neurectomy in cadavers with appropriate anatomy.
Source: American Journal of Otolaryngology - Category: Endocrinology Source Type: research
ConclusionThe results of this retrospective review demonstrate a low risk for hearing loss due to SSCD surgery via the middle fossa craniotomy approach.
Source: Journal of Clinical Neuroscience - Category: Neuroscience Source Type: research
Publication date: Available online 13 June 2017 Source:Journal of Clinical Neuroscience Author(s): Nolan Ung, Lawrance K. Chung, Carlito Lagman, Nikhilesh S. Bhatt, Natalie E. Barnette, Vera Ong, Quinton Gopen, Isaac Yang Superior semicircular canal dehiscence (SSCD) is a rare defect of the arcuate eminence that causes an abnormal connection between the superior semicircular canal and middle cranial fossa. Patients often present with a variety of auditory and vestibular symptoms. Trigger avoidance is the initial strategy, but surgery may be necessary in debilitating cases. We retrospectively reviewed SSCD patients undergo...
Source: Journal of Clinical Neuroscience - Category: Neuroscience Source Type: research
Conclusions Many studies have focused on genetic and inflammatory mechanisms contributing to cerebral cavernous malformation rupture, but few have reported on the potential of hemodynamic changes contributing to cerebral cavernous malformation rupture. Systemic blood pressure changes clearly have an effect on angioma pressures. When considering the histopathological features of cerebral cavernous malformation architecture, changes in arterial pressure could cause meaningful alterations in hemorrhage propensity and patterns.
Source: Journal of Medical Case Reports - Category: Journals (General) Source Type: research
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