The retrolabyrinthine approach and vascular loop.

Several researchers have made progress toward determining the cause of hemifacial spasm, tinnitus, and episodic vertigo. During the past 5 years, we have encountered a vascular loop in six of 36 patients who were undergoing retrolabyrinthine vestibular neurectomy for recurrent disequilibrium and vertigo. In five of these six patients, disequilibrium improved after neurectomy. This report describes the clinical symptomatology and the results of preoperative cochleovestibular testing for those patients found intraoperatively to have a vascular loop and suspected neurovascular compression syndrome. Audiograms, although varied, characteristically did not demonstrate the low-frequency sensorineural hearing loss characteristic of Meniere's disease. No preoperative marker, with the single exception of computed tomography pneumocisternography, dependably predicted the presence of a vascular loop.

Surgical treatment of vertigo with retrolabyrinthine vestibular neurectomy.

Results for control of vertigo and preservation of hearing in patients who have had a retrolabyrinthine vestibular neurectomy (RVN) by our group were analyzed retrospectively. This procedure consists of selective section of the vestibular nerve in the posterior cranial fossa. Vertigo was completely controlled in all but two of 31 patients, one of whom required revision surgery to control attacks. Analysis of these two cases suggests that the cause of persistent vertigo is incomplete neurectomy. With our current surgical technique in patients with Meniere's disease, hearing results were not statistically different from our results with surgery of the endolymphatic sac. Control of vertigo was much more successful with the RVN than endolymphatic sac surgery.

Complications in the approach to acoustic tumor surgery.

Earlier diagnosis and cooperation with allied specialists in neurosurgery have lessened complications of acoustic tumor surgery. To date, complications cannot always be prevented. The controversy over which approach is best for acoustic tumor extirpation still continues. While teams must answer this question themselves, our experience favors the transtemporal approach. Of the potential disabilities from this operation, facial paralysis or its sequelae remain the most frequent. The transtemporal approach gives a more accurate anatomical definition of the facial nerve. Efforts to preserve hearing (especially with tumors 2 cm or larger), when matched with the potential sequelae of facial paralysis, may prove futile.