Meniere Disease: Vestibular Neurotomy, Why, How, What Results?

Objective: Meniere disease is rare and usually controlled by medical therapies; but in 10% of cases, it becomes a real incapacitating disease. The quality of professional, familial and social patients' lives becomes severely affected. In these cases, the most important goal is to control vertigo crisis and for a long time we know that the total vestibular denervation is quite always effective on this symptom. So, vestibular neurotomy seems to be the procedure of choice to cure these patients. Material and Methods: In our department, from 2003 to 2013, 135 vestibular neurotomies were performed by retrosigmoid approach. We propose to study our population and evaluate our results on vertigo crisis, hearing thresholds and quality of life 3 years at least after the procedure. Results: The minimally invasive retrosigmoid approach is not technically difficult, providing excellent access and allowing a sure and safe section of the vestibular nerve. No severe complication was observed in our population. After 3 years, more than 97% of patients are definitively cured from their vertigo crisis after surgery. The auditory thresholds are not affected, tinnitus is unchanged, and quality of their life clearly improved. Conclusion: To be efficient the vestibular neurotomy must cut the whole nerve, all the nerve, and only the nerve.