This operation is considered in patients who have severe Meniere’s disease with attacks of vertigo that continue despite aggressive medical management and still have good hearing in the affected ear. As it is the most invasive and risky of the surgical procedures offered for this condition, other options first considered. If all other therapies are exhausted and the patient’s hearing is still useful in the affected ear, then this surgery is considered. An artery surrounds the nerve bundle. The patient is admitted to hospital after the operation and the length of stay is on average several days, with a 24 hour observation period in the Intensive Care Unit. This is because the operation involves opening the envelope of the brain, called the dura mater, either through the mastoid or via a craniotomy, depending on anatomy. The back of the brain, the cerebellum, is retracted delicately to reveal the vestibular nerve, which runs with the hearing fibers, the cochlear nerve, in the “vestibulocochlear nerve”, or the Viii cranial nerve. The fibers of the vestibular nerve are identified and carefully cut, leaving the cochlear nerve fibers intact. The landmark between these 2 sets of fibers is sometimes not clear.
The dura mater and the mastoid or craniotomy are then closed with a variety of materials, and the patient is observed in the intensive care unit. Because the balance fibers are cut suddenly, the surgery causes intense vertigo and imbalance for a few days requiring supportive medical care, medications for nausea and eventually physical therapy. A cane or walker may be needed for a while, depending on the patient’s health and activity level prior to the surgery. Once the patient is able to ambulate safely, he may be discharged home, but vestibular and balance therapy is continued on an out-patient basis to speed the patient’s recovery as much as possible. A return to full function occurs in most patients, although many do feel imbalanced when tired or stressed.
