Long-term efficacy of vestibular neurotomy in disabling Ménière’s disease and Tumarkin drop attacks

Author:

Véleine Yohanan1,Brenet Esteban1,Labrousse Marc1,Chays André12,Bazin Arnaud23,Kleiber Jean-Charles23,Dubernard Xavier12

Affiliation:

1. Department of Otorhinolaryngology, Head and Neck Division, Robert Debré Hospital, Reims University Hospital;

2. Otoneurosurgical Institute of Champagne-Ardenne, Head and Neck Division, Maison Blanche Hospital, Reims University Hospital; and

3. Department of Neurosurgery, Head and Neck Division, Maison Blanche Hospital, Reims University Hospital, Reims, Grand Est Region, France

Abstract

OBJECTIVE When Ménière’s disease (MD) becomes disabling due to the frequency of attacks or the appearance of drop attacks (i.e., Tumarkin otolithic crisis) despite "conservative" medical and surgical treatments, a radical treatment like vestibular neurotomy (VN) is possible. An ideal MD treatment would relieve symptoms immediately and persist after the therapy. The aim of this study was to identify if VN was effective after 10 years of follow-up regarding vertigo and drop attacks, and to collect the immediate complications. METHODS The authors report a retrospective, single-center (i.e., in a single tertiary referral center with otoneurological surgery activity) cohort study conducted from January 2003 to April 2020. All patients with unilateral disabling MD who had received a VN with at least 10 years of follow-up were included. The therapeutic efficacy was defined by complete disappearance of vertigo and drop attacks. The postoperative complications (CSF leak, total deafness, meningitis, death) were determined immediately after the surgery, and the hearing thresholds were determined during the patient follow-up with the pure tone average (PTA). RESULTS A total of 74 patients (of 85 who were eligible), average age 51.9 ± 11.1 years, including 38 men (51.4%), with disabling MD and/or Tumarkin drop attacks (24.3%) received VN, with at least 10 years of follow-up after surgery. After an average follow-up of 12.4 ± 1.7 years (range 10.0–16.3 years), 67 patients (90.5%) no longer presented any vertiginous attacks, and no patient experienced drop attack. The mean variation in early pre- and postoperative PTA was not statistically significant (n = 64, 2.2 ± 10.3 decibels hearing level [range −18 to 29], 95% CI [−0.4 to 4.37]; p = 0.096), and 84.4% of the patients evaluated had unchanged or improved postoperative PTA. Three significant complications were noted, including two surgical revisions for CSF leak. There was no permanent facial paralysis, meningitis, or death. CONCLUSIONS In case of disabling MD (disabling vertigo refractory to conservative vestibular treatments—Tumarkin drop attacks), VN via the retrosigmoid approach must be the prioritized proposal in comparison to intratympanic gentamicin injections, because of the extremely low complication rate and the immediate and long-lasting effect of this treatment on vertigo and falls.

Publisher

Journal of Neurosurgery Publishing Group (JNSPG)

Subject

Genetics,Animal Science and Zoology

Reference40 articles.

1. Evaluation of retrosigmoid vestibular neurectomy for intractable vertigo in Ménière’s disease: an interdisciplinary review;Li CS,2008

2. Drop attacks with Menière’s syndrome;Baloh RW,1990

3. Drop attacks in older patients secondary to an otologic cause;Ishiyama G,2001

4. Association between syncope and Tumarkin attacks in Ménière’s disease;Pyykkö I,2019

5. Committee on Hearing and Equilibrium guidelines for the diagnosis and evaluation of therapy in Menière’s disease. American Academy of Otolaryngology–Head and Neck Foundation, Inc,1995

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