Evaluation of Vestibular Neurotomy Efficacy and Security for Disabling Meniere’s Disease and Tumarkin Syndrome: A Retrospective Study of 157 Patients

Background and objective: Meniere's disease (MM) rarely escapes conservative medical or surgical treatments. When it becomes severely disabling due to recurrence of seizures and neuro-vegetative signs or when it's complicated by Tumakin syndrom, radical treatment such as vestibular neurotomy (NV) suppressing function vestibular is necessary. The objective of the study is define the efficacy and safety of NV.

Methods: Retrospective, monocentric study (2003-2015) about patients suffering from disabling MM and/or complicated by Tumarkin syndrome who treated by retrosigmoid NV. Diagnosis of probable or definite MM was based on clinical evaluation of patients (AAO-HNS 2015 criteria). Disabling and pre/postoperative auditory thresholds were determined from AAO-HNS 1995 criteria. Therapeutic efficacy (complete disappearance of vertigo and falls), postoperative complications and variation of auditory thresholds (variation of Pure Tone Average -PTA- pre/postoperative) are determined at 6 month and 3 and 10 year.

Results: 157 patients (mean age: 52 years [22-75]; 49.7% of women), with disabling MM (grade ≥4 on the AAO-HNS disability scale: 98.88%) and/or Tumarkin syndrome (31%), benefited from NV. Efficiency on vertigo and falls was total at 6 month, 90% at 3 years (n=89) and 90% at 10 years (n=31). The echec was two incomplete sections and one suspicion of bilateralization. No per or postoperative deaths are reported and 4,45% serious complications are observed (three rhinoliquorrhea, two aseptic late meningitis, one massive pulmonary embolism, one scarring infection). The variation of pre/postoperative PTA is not statistically significant (mean = -0.45 dB, IC95 [-2.48, 1.99], p=0.83).

Conclusion: NV is a radical surgical treatment whose risk, including auditory, is low compared to the almost total effectiveness on the control of vertigo. This treatment should be proposed in severely disabling cases and Tumarkin syndromes.