[Vestibular neurotomy by a retrosigmoid approach: functional results. Evaluation through a triple clinical approach (otoneurologic, orthoptic and physical medicine)].
Vestibular neurotomy remains the surgical procedure of choice in the management of peripheral vertigo resistant to the usual medical treatment, for patients with preserved hearing. Menière's disease generally sums up most of the surgical indications. The authors report a personnel series of patients who underwent vestibular neurotomy during the last five years, from January to December 1998. The aim of this study was to assess with a 6 months to 3.5 years follow-up, postoperative complications and functional results, particularly the improvement of dizziness, residual unsteadiness and its impact on quality of life, and the recovery of socio-professional and physical activities. Of a total of 41 patients, 21 were evaluated by both an otoneurologic and physical medicine approach, to analyze the main sensory components of equilibrium (vestibular, proprioceptive, cervical, visual). In most of the cases, the results show disappearance of vertigo which was the main complaint. However, disabling residual instability is common in those patients who was present both a cervical pathology and binocular visual impairment or a defect in convergence, often unrecognised. The authors emphasise the necessity of a cervical examination and orthoptic investigations in addition to the vestibular assessment. This multi-disciplinary approach allows better identification of the different factors (vestibular, cervical, orthoptic) and lead to specific rehabilitation which can permit the patient with residual unsteadiness to return to work and lifestyle, the real measure of success of vestibular neurotomy.
Parietti
C
C
CHU-Hôpital Central, Service O.R.L. et Chirurgie Cervico-faciale, Nancy, France.
Bussienne
J E
JE
Knecht
C
C
Beurton
R
R
Simon
C
C
D000328:Adult; D000368:Aged; D001299:Audiometry / Q000379:methods; D005260:Female; D006801:Humans; D008297:Male; D008575:Meniere Disease / Q000601:surgery*; D008875:Middle Aged; D010808:Physical Examination; D016896:Treatment Outcome; D015348:Vision, Binocular