Anatomical Factors Influencing Selective Vestibular Neurectomy: A Comparison of Posterior Fossa Approaches

Adam N. Master; Jose M. Flores; L. Gale Gardner; Maura K. Cosetti

doi:10.1055/s-0035-1556876

Journal of Neurological Surgery Part B: Skull Base, Table of Contents

J Neurol Surg B Skull Base 2016; 77(01): 019-023
DOI: 10.1055/s-0035-1556876

Original Article

Georg Thieme Verlag KG Stuttgart · New York

Anatomical Factors Influencing Selective Vestibular Neurectomy: A Comparison of Posterior Fossa Approaches

Adam N. Master

¹Departments of Otolaryngology-Head and Neck Surgery and Neurosurgery, Louisiana State University Health Sciences Center Shreveport, Shreveport, Louisiana, United States

,

Jose M. Flores

²Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, United States

,

L. Gale Gardner

¹Departments of Otolaryngology-Head and Neck Surgery and Neurosurgery, Louisiana State University Health Sciences Center Shreveport, Shreveport, Louisiana, United States

,

Maura K. Cosetti

¹Departments of Otolaryngology-Head and Neck Surgery and Neurosurgery, Louisiana State University Health Sciences Center Shreveport, Shreveport, Louisiana, United States

› Author Affiliations

Abstract

Objectives To identify measurable anatomical factors that may guide the surgical approach for posterior fossa selective vestibular neurectomy (SVN) and predict identification of the vestibulocochlear cleavage (VCC) plane.

Study Design Dissection of fixed cadaveric heads through retrolabyrinthine and retrosigmoid-internal auditory canal (RSG-IAC) approaches with measurement of landmarks.

Setting Cadaveric dissection model.

Main Outcome Measures Area of the Trautmann triangle (TT) and the distance from the posterior semicircular canal to the anterior border of the sigmoid along the posterior Donaldson line (pDL). VCC planes from each approach were calculated and compared.

Results Overall mean pDL was 8.53 mm (range: 5–11.5 mm); mean TT area was 124 mm² (range: 95–237 mm²). The VCC was identified in 63% of ears through the retrolabyrinthine (RVN) approach alone, whereas 37% of ears required the RSG-IAC approach. In ears requiring IAC dissection, the VCC was found within 1 to 2 mm distal to the porus. The pDL (p < 0.05) and area of TT (p < 0.05) were significantly larger in the RVN group compared with the RSG-IAC group.

Conclusion Ears amenable to the RVN approach had a greater pDL and TT area. These anatomical measurements may have a role in surgical planning and the choice of approach for SVN.

Keywords

vestibular neurectomy - Meniere disease - retrolabyrinthine - retrosigmoid - vertigo

Full Text

References

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