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At least 127 records · Page 7Linked to original sources

PubMed1994

Vestibular nerve section.

In the nearly 90 years since Frazier first performed an eighth nerve section through the posterior fossa for the treatment of Ménières's disease, the surgical management of Ménière's disease has come full circle. With refinements in surgical technique and advancements in instrumentation, optics, illumination, and neuromonitoring, a procedure that was once resoundingly condemned by the otologic community is now regarded as the procedure of choice in patients with serviceable hearing. The vestibular nerve section has experienced a renaissance. The posterior fossa vestibular nerve section has undergone an evolution, and the combined retrolabyrinthine-retrosigmoid vestibular nerve section represents the highest form. It is a significant improvement over its predecessors and our procedure of choice in properly selected patients.

Humans↗

PubMed2003

Vertigo from herpes zoster oticus: superior or inferior vestibular nerve origin?

OBJECTIVE/HYPOTHESIS: This study aims to analyze which division of vestibular nerve in the internal auditory canal is responsible for inducing vertigo in patients with herpes zoster oticus (HZO). METHODS: Eight patients (three men and five women) suffered from auricular vesicles, otalgia, and facial palsy, and five of them also had vertigo. Each patient received a battery of tests, including neurological examination, blood examination, audiometry, caloric test, electronystagmography, and vestibular evoked myogenic potential (VEMP) test. RESULTS: All five HZO patients with vertigo had facial palsy on the lesioned side and spontaneous nystagmus beating toward the healthy side. Absent VEMPs were noted in five patients, absent caloric response was noted in four, and sensorineural HL was noted in three. Compared to another three HZO patients without vertigo, all revealed normal responses in both the caloric test and the VEMP test. On MRI scan, two out of four had abnormal gadolinium enhancement along the nerve segments within the internal auditory canal. Six months after treatment, a follow-up caloric test and VEMP test in these eight patients did not alter the results compared with before treatment. CONCLUSION: The nerve trunks within the internal auditory canal are widely affected in HZO patients with vertigo. Both superior division and inferior division of the vestibular nerve attribute to the vertiginous attack. Further, large numbers of HZO patients undergoing caloric testing and VEMP testing are required to support this tentative conclusion.

Adolescent↗

PubMed2005

Delayed quick spins after vestibular nerve section respond to anticonvulsant therapy.

OBJECTIVE: To describe the clinical features of patients with failed vestibular nerve section that have a response to anticonvulsant medication. STUDY DESIGN: Retrospective case review. SETTING: Ambulatory tertiary referral center. PATIENTS: We report three patients who were afflicted with frequent brief spinning spells, or "quick spins," after vestibular neurectomy for Meniere's disease. INTERVENTION: Treatment with anticonvulsants. MAIN OUTCOME MEASURE: Relief of vertigo. RESULTS: All cases had an excellent therapeutic response to carbamazepine or oxcarbazepine, agents conventionally used for neuralgia, suggesting that these symptoms are caused by a hyperexcitable vestibular nerve. CONCLUSION: Treatment of neuralgia should be considered when the symptom of quick spins arises after vestibular neurectomy.

Adult↗

PubMed1996

Vestibular nerve dysfunction and decompression in Engelmann's disease.

Vestibular nerve dysfunction as the major neuro-otological symptom in one of the osteopetrosis group of bone disorders is unusual. We describe a patient with Engelmann's disease who presented in this manner and who benefited from an eighth nerve decompression procedure. Surgical decompression of the internal auditory meatus to relieve vertigo has to our knowledge not been previously reported in this condition.

Adult↗

PubMed1983

Vestibular nerve input to neck and shoulder regions of lateral cuneate nucleus.

Axonal transport of tritiated leucine by the vestibular nerve was observed in regions of the ipsilateral lateral cuneate nucleus (LCN) that were determined electrophysiologically to receive somatosensory input from the neck and shoulder and to respond to electrical stimulation of the vestibular nerve. Regions of the LCN receiving input from more distal musculature did not receive vestibular input.

Animals↗

PubMed1988

Hearing results and control of vertigo after retrolabyrinthine vestibular nerve section.

To determine the effect of retrolabyrinthine vestibular nerve section (RVNS) on hearing, vertigo, and associated symptoms, we reviewed our experience in 48 patients. Of the 48, 39 responded to a questionnaire. Although RVNS appeared to have little effect on hearing in Meniere's patients, 91% of non-Meniere's patients had significant and often delayed postoperative sensorineural hearing loss. Our results for vertigo control compared favorably to previous reports with 96% of Meniere's patients and 69% of non-Meniere's patients reporting improvement. Presently, we more frequently recommend RVNS as the primary procedure for the control of severe vertigo in Meniere's patients. Patients with vertigo from other causes must be carefully selected.

Follow-Up Studies↗

PubMed1997

Electrocochleography in retrosigmoid vestibular nerve section for intractable vertigo caused by Menière's disease.

Interest in electrocochleography has increased in recent years because of the discovery of an elevated summating potential to action potential amplitude ratio (SP/AP ratio) in patients with endolymphatic hydrops caused by Menière's disease or perilymph fistula. It was the purpose of this investigation to determine whether the intraoperative SP/AP ratio will decrease after vestibular nerve section in patients with intractable Meniere's disease. Fourteen patients with medically intractable classic Menière's disease underwent retrosigmoid vestibular nerve section. Intraoperative transtympanic electrocochleography was performed with alternating click stimuli presented at 95 dB HL. In all patients the SP/AP ratio was recorded before the skin incision ("baseline" condition) and after the dura was closed ("closing" condition). Statistical analysis was applied to the recorded data. In 11 (79%) patients, the SP/AP ratio was found to be elevated above 0.30 in the baseline state. In 13 (93%) patients, the SP/AP ratio decreased more than 25% after the nerve was sectioned. These results were highly statistically significant (p < 0.001). We conclude that the SP/AP ratio does decrease in patients with Menière's disease after undergoing retrosigmoid vestibular nerve section and offer a possible explanation.

Adult↗

PubMed1986

Vestibular nerve section and saccus decompression: an evaluation of long-term results.

The 1972 AAOO committee (Alford, 1972) guidelines brought some uniformity into the evaluation of therapy for Menière's Disease. We have adhered to its recommendations in this long-term follow-up report of 21 saccus decompressions and 29 vestibular nerve sections performed on 46 patients between 1968 and 1977. Comparisons between these and other groups have been possible with regard to: control of vertigo; hearing; tinnitus; and development of hydrops in the contralateral ear. All the vestibular nerve section group have enjoyed sustained relief from vertigo. Class D results (recurrent vertigo) account for 14 per cent of the saccus decompression group at one year and 29 per cent at eight to 10-year follow-up. Hearing levels in both groups deteriorated in parallel as time progressed but tinnitus became less noticeable. Nineteen per cent of the long-term review patients showed evidence of developing cochlear hydrops in the contralateral ear. Conservative surgical procedures should be employed whilst any useful hearing exists, though the emphasis remains on controlling vertigo. Saccus decompression, despite its controversial therapeutic basis, will remain the first-line surgical procedure for many otologists. However, in the fit young Menière's cripple or saccus decompression failure with serviceable hearing, vestibular nerve section remains the treatment of choice.

Adult↗

PubMed2002

Vestibular nerve section.

When the vertigo of Meniere's disease becomes refractory to medical management, a variety of surgical options are available. If intratympanic gentamicin has failed or is not recommended and serviceable hearing is present, sectioning the vestibular nerve is an excellent option in terms of vertigo control, hearing preservation, and postoperative quality of life. Transection of the vestibular nerve has gone through a metamorphosis since attempted by Krause over a century ago. The microsurgical posterior fossa vestibular neurectomy has undergone an evolution, resulting in the combined RRVN. This is essentially a retrosigmoid approach with exposure of the lateral venous sinus to allow forward retraction of the sinus and better exposure. This technique has the advantages of minimization of required mastoid and suboccipital bone work, elimination of the need for cerebellar retraction, improved exposure, ability to achieve watertight dural closure to minimize incidence of CSF leakage, low incidence of postoperative headache, and low overall complication rate. If a cleavage plain cannot be readily identified, then the superior half of the eighth nerve is sectioned near the brainstem. The results are essentially the same whether the vestibular nerve is cut in the IAC or the posterior fossa. Vertigo has been completely controlled in 85% and hearing has been preserved at the preoperative level in 80% of patients. Combined RRVN is a direct and safe technique, with high success in properly selected patients.

Hearing↗

PubMed1984

Anatomical characteristics of the anterior vestibular nerve of the bullfrog.

Study was made of the dimensions of the nerves to the receptor organs in the anterior branch of the bullfrog vestibular nerve. The number of fibers and their diameters and trajectories in the nerve and Scarpa's ganglion were studied. A correlation was made between the anatomical and physiological properties of neurons identified with intracellular injections of horseradish peroxidase. The data suggest a specific pattern of innervation of the organs, organization of fibers and cells in the vestibular nerve, and significant correlation between the anatomical and physiological properties of individual neurons. A comparison was made between the information obtained from the bullfrog and that from other animals, which suggests a similarity between species and supports the hypothesis of a differential physiological role of the neurons in each vestibular organ according to anatomical characteristics.

Animals↗

PubMed1986

Retrolabyrinthine vestibular nerve section: analysis of results.

The retrolabyrinthine section of the vestibular nerve is an effective procedure for the ablation of unilateral vestibular function while preserving hearing. Although this procedure has been most frequently used for the control of unilateral Meniere's disease, it may also be effective in the control of unilateral vestibular dysfunction of other etiologies. A 2-year experience with the indications for and the surgical results in a series of patients who underwent this procedure is presented. Brief case histories of a variety of etiologies of unilateral vestibular dysfunction are discussed.

Audiometry, Pure-Tone↗

PubMed1993

Surgery for vertigo in the nonserviceable hearing ear: transmastoid labyrinthectomy or translabyrinthine vestibular nerve section.

Two of the surgical options that exist for the treatment of disabling vertigo arising from an ear with nonserviceable hearing are a transmastoid labyrinthectomy (TL) and a translabyrinthine vestibular nerve section (TLVNS). The major difference between the two operations is a section of the vestibular nerves with the TLVNS which removes all preganglionic vestibular tissue from the diseased inner ear. It has been inferred that a TLVNS should be the procedure of choice if hearing is not to be spared, because a TL results in an incomplete removal of preganglionic vestibular tissue, and that this remaining tissue might have continued or recurrent physiologic function resulting in further vertigo. The clinical outcome of 58 patients who had either TL or TLVNS for disabling vertigo arising from a nonserviceable hearing ear was investigated with respect to the control of vertigo and the development of postoperative balance dysfunction. The control of vertigo in the TLVNS and TL groups was 100% and 95.3%, respectively. This difference was not statistically significant. There was a tendency for postoperative dysequilibrium to be more frequent in the TLVNS group, but this finding did not reach statistical significance. A TL appears to offer the same benefit as TLVNS in the control of intractable episodic vertigo without the additional risks of TLVNS.

Adolescent↗

PubMed1994

Acoustically responsive fibers in the vestibular nerve of the cat.

Recordings were made from single afferent fibers in the inferior vestibular nerve, which innervates the saccule and posterior semicircular canal. A substantial portion of the fibers with irregular background activity increased their firing in response to moderately intense clicks and tones. In responsive fibers, acoustic clicks evoked action potentials with minimum latencies of < or = 1.0 msec. Fibers fell into two classes, with the shortest latency either to condensation clicks (PUSH fibers) or to rarefaction clicks (PULL fibers). Low-frequency (800 Hz) tone bursts at moderately high sound levels (> 80 dB SPL) caused synchronization of spikes to preferred phases of the tone cycle. PUSH and PULL fibers had preferred response phases approximately 180 degrees apart. These two response classes are consistent with fibers that innervate hair cells having opposite morphological polarizations, an arrangement found in the saccule. With low-frequency tone bursts, sound levels of > or = 90 dB SPL evoked increases in mean spike rate. Spike rates increased monotonically with sound level without saturating at levels < or = 115 dB SPL. Contraction of the middle-ear muscles decreased responses to sound, consistent with the sound transmission path being through the middle ear. Several fibers were labeled with biocytin and traced. All labeled fibers had bipolar cell bodies in the inferior vestibular ganglion with peripheral processes extending toward the saccular nerve and central processes in the vestibular nerve. Two fibers were traced to the saccular epithelium. One fiber was traced centrally and arborized extensively in vestibular nuclei and a region ventromedial to the cochlear nucleus. Our results confirm and extend previous suggestions that the mammalian saccule responds to sound at frequencies and levels within the normal range of human hearing. We suggest a number of auditory roles that these fibers may play in the everyday life of mammals.

Acoustic Stimulation↗

PubMed1979

[Vestibular results before and after neurectomy of the vestibular nerve in cases of vertigo resistant to medical treatment (author's transl)].

25 patients suffering from vertigo due to peripheral-vestibular disorders resistant to medical treatment underwent neurectomy of the vestibular nerve. Präoperatively 24 showed a pathological result in the neurotological examination. In 83% of the cases an abnormal caloric reaction could be seen in the frequency-calorigram, which graphically represents the caloric test. The postoperative objective vestibular results always correlated with the subjective feeling of vertigo. We could see a decrease and finally a disappearance of the horizontal unidirectional spontaneous nystagmus. It is of value to examine the gaze nystagmus in none directions of gaze. In the positiogram, a quantitative scheme of the positional test, one could recongize a decrease of the nystagmus intensity in the follow-up examination. The same was found by testing the vestibulo-spinal reactions. Although the neurectomy of the vestibular nerve involves a serious operation it is nevertheless the first choice of treatment. 96% of the cases are free from vertigo. Postoperative there is a very low complication quota.

Adult↗

PubMedDate not supplied

High resolution Gd-DTPA MR imaging of the inner ear in 60 patients with idiopathic vestibular neuritis: no evidence for contrast enhancement of the labyrinth or vestibular nerve.

Sixty patients with acute idiopathic vestibular neuritis (confirmed by clinical examination and caloric irrigation) were evaluated in a prospective study by high resolution magnetic resonance imaging (hr-MRI) between days 3 and 30 after onset of symptoms. We used a 1.5 Tesla imager with an axial and coronal T1-weighted 2D-fast low angle shot-, T2-weighted turbo spin echo-, and an axial T2-weighted 3D-constructive interference in steady-state sequence for MRI. None of the patients' MRIs exhibited contrast enhancement of the labyrinth, vestibulocochlear nerve, or vestibular ganglion, even when high doses of gadolinium (0.2 mmol/kg) were used. In contrast, several previous studies demonstrated contrast enhancement of the vestibulocochlear nerve/labyrinth in herpes zoster oticus, labyrinthitis, and Cogan's syndrome or of the facial nerve in Bell's palsy. On the basis of our MRI findings, we speculate that idiopathic vestibular neuritis is neither a viral infection directly affecting the nerve (such as herpes zoster) nor a labyrinthitis. An autoimmunological disease of the labyrinth, which should involve only the anterior and horizontal semicircular canals, is also unlikely. A subacute reactivation of a latent viral infection--as discussed for Bell's palsy--is compatible with our MRI findings. The observed differences between contrast enhancement of the facial nerve in Bell's palsy and the vestibulocochlear nerve in vestibular neuritis may be due to their dissimilar anatomy: contrary to the vestibular nerve, the facial nerve has very prominent circumneural arteriovenous structures. Hyperemia within these vascular structures may cause the contrast enhancement seen in Bell's palsy.

Acute Disease↗

PubMed1987

Vestibular nerve section in patients with chronic otitis media.

Retrolabyrinthine vestibular neurectomy preserves hearing and relieves intractable vertigo emanating from the inner ear. However, this approach must be modified in patients with prior "canal-wall-down" procedures. Traversing an exteriorized mastoid cavity risks bacterial contamination of the subarachnoid space. Three patients seen at the Otologic Medical Group with prior canal-wall-down procedures required vestibular neurectomy for persistent vertigo. Using the retrosigmoid approach, the vestibular nerve was sectioned without sacrificing hearing and without traversing a potentially infected mastoid cavity. It is recommended that this approach be considered in patients with intractable vertigo, serviceable hearing, and exteriorized mastoid cavities.

Aged↗

PubMed1997

The role of vestibular nerve section in Menière's disease.

The role of vestibular nerve section (VNS) surgery in the management of Menière's disease is considered by prospective analysis of a large series of 531 patients treated by the author over a period of 11 years. Twenty-seven percent were referred by their primary care physicians, while the rest were secondary (45.6%) or tertiary (27.3%) referrals. Overall, 62 (11.7%) Menière's patients underwent 63 VNS procedures. This surgery was undertaken more frequently in the secondary and tertiary referral patients (14.2%) than in the primary referrals (5.5%). The retrolabyrinthine technique was the preferred approach in almost 90% of ears. The results and complications of these and other surgical options are discussed in an attempt to define the present role of VNS in intractable Meniere's disease. Vertigo was abolished after VNS in 93% of cases. Compensation was significantly impaired in 12.9%. All these patients had contralateral Menière's disease or marked labyrinthine hypofunction. Although highly effective and associated with few postoperative complications, VNS is generally reserved for sac failures, though may be appropriate as a primary procedure in severe unilateral cases.

Adolescent↗

PubMed1998

Vestibular nerve regeneration in the bullfrog, Rana catesbeiana: peripheral dendrites.

Three experiments were conducted on healthy adult bullfrogs (Rana catesbeiana) for the purpose of investigating three characteristics of centrifugal vestibular afferent regeneration after complete transection of the anterior division of the vestibular nerve (AVN). In experiment 1 total fiber count and axon diameter measurements were obtained from the anterior canal nerve at three different time periods and compared with normal. The normal group (n = 3) demonstrated a total fiber count of 1001 +/- 76 (SEM). The early time period (1 to 2 weeks, n = 3) did not completely regenerate as demonstrated by a total fiber count of 282 +/- 23. The intermediate (4 to 6 weeks, n = 3) and late (8 to 16 weeks, n = 3) groups exhibited total fiber counts of 907 +/- 29 and 946 +/- 50, respectively, which were not different from normal (Mann-Whitney U, p > 0.2). Evaluation of fiber diameter distribution of the intermediate and late regenerated nerves revealed a reduction in axon diameter caliber compared with normal (analysis of variance, p < 0.0001). Thus transection of the AVN results in regeneration of all afferents that exhibit a reduction in axon diameter. In experiment 2 fibers innervating the anterior canal crista (ACC) were prelabeled before nerve transection. After the labeling procedure the AVN (n = 3) was sectioned at a location that resulted in denervation of three vestibular receptors: the ACC, horizontal canal cristae (HCC), and utricular macula. After 4 weeks of regeneration the ACC fibers that were prelabeled were observed innervating all three denervated vestibular receptors. This result demonstrated that reinnervation of the peripheral vestibular end organs after AVN transection is a nonspecific process. In experiment 3, 167 regenerated canal afferents were evaluated for functional recovery 16 weeks after transection. Both spontaneous and rotation-induced discharge characteristics were obtained and compared with those obtained from a sample of 254 normal afferents in a previous study (Hoffman LF. Factors affecting the response dynamics of canalicular primary afferent neurons in the bullfrog. St. Petersburg (FL): Association for Research in Otolaryngology; 1989). The mean spontaneous discharge coefficient of variation (CV) +/- standard deviation was 0.60 +/- 0.32 and 0.49 +/- 0.33 for ACC and HCC regenerated afferents, respectively, which did not differ from the normal means of 0.63 +/- 0.33 and 0.54 +/- 0.36 (Mann-Whitney, p > 0.2). Response gains and phases obtained during 0.05 Hz sinusoid rotations at 15 degrees/second maximum horizontal table velocity also demonstrated normal discharge characteristics. The mean phases were -28.2 +/- 25.2 degrees and -55.9 +/- 21.5 degrees for regenerated ACC and HCC afferents, respectively, which were not different from the normal means of -33.77 +/- 24.31 degrees and -58.0 +/- 23.3 degrees (Mann-Whitney U). Furthermore, regenerated afferents exhibited a positive association between phase and CV, which was also true for normal afferents (correlation analysis, p > 0.001). Although the mean gains for regenerated ACC and HCC (7.13 +/- 5.5 and 3.3 +/- 2.4 spikes x sec(-1)/degrees x sec(-2), respectively) afferents were reduced from normal ACC and HCC (14.8 +/- 12.52 and 7.76 +/- 6.58 spikes x sec(-1)/degrees x sec(-2), respectively) afferents (Mann-Whitney U, p > 0.0001), a positive association between gain and CV was also demonstrated by regenerated afferents, as was the case for normal afferents (correlation analysis, p < 0.001). Thus the overall response discharges of regenerated afferents were comparable with normal afferents. Normally, large fibers innervate central regions of the receptor, and smaller fibers innervate the peripheral regions. However, the data from experiments 1 and 2 demonstrate that vestibular nerve regeneration results in a dissociation between the normal topographic organization of fiber size and regional innervation of the receptor epithelium. (ABSTRACT TRUNCATED)

Animals↗