Retrosigmoid Approach to Vestibular Nerve Section

Abstract

At the September 1986 meeting of the American Academy of Otolaryngology—Head and Neck Surgery in San Antonio, Tex, Dr Herbert Silverstein, Sarasota, Fla, presented his results in 91 vestibular neurectomies for relief of vertigo. The operation was performed via a middle fossa approach in 20 cases, via the retrolabyrinthine approach in 65 cases, and via a retrosigmoid, suboccipital approach in six recent cases. Dr Silverstein reported an overall 93% success rate for relief of vertigo. The middle fossa approach has been associated with a 3% to 7% incidence of facial weakness and occasional total deafness, and it is technically difficult. The retrolabyrinthine approach has had a lower morbidity rate and is technically easier; however, with this technique the cochleovestibular nerve is approached between the brain stem and the porus acusticus, and in 25% of cases the division between the cochlear and the vestibular nerves has been poorly defined. In the