Retrosigmoid Vestibular Neurectomy for Meniere Disease: A Technical Note

Edoardo Porto, J. Manuel Revuelta Barbero, Eduardo Medina, Tomas Garzon-Muvdi, Douglas E. Mattox, C. Arturo Solares, Esther X. Vivas, Gustavo Pradilla

Research output: Contribution to journalArticlepeer-review


Background: Meniere disease (MD) is an idiopathic peripheral pathology involving the acoustic apparatus. One of the most critical challenges in managing MD is intractable vertigo. In this context, retrosigmoid vestibular neurectomy has been described as a safe and effective technique to manage this symptom when it is resistant to first- and second-line treatments. This article analyzed the alternative treatment options, specific surgical anatomy, and relevant details of vestibular neurectomies performed for intractable MD. Methods: Relevant neurovascular landmarks, critical surgical steps, adequate indications, and potential pitfalls of retrosigmoid vestibular neurectomy were analyzed based on an illustrative clinical case of intractable MD. Results: The illustrative case demonstrated how early recognition of the facial nerve and the vestibulocochlear plane is fundamental to performing retrosigmoid vestibular neurectomy. This procedure is indicated in cases of resistant MD with preoperative hearing integrity. Potential pitfalls of this technique are incomplete neurotomy, nerve regeneration, comorbidities in the contralateral ear, adverse anatomy, the possibility of nonotologic vertigo, and incomplete vestibular compensation. Conclusions: Vestibular neurectomy represents a safe and effective technique to manage MD that is resistant to medical treatment, allowing symptom control and hearing preservation. Nevertheless, detailed knowledge of surgical anatomy and possible pitfalls is of paramount importance to achieve a good outcome.

Original languageEnglish (US)
Pages (from-to)71-75
Number of pages5
JournalWorld neurosurgery
StatePublished - Apr 2022
Externally publishedYes


  • Meniere syndrome
  • Neurectomy
  • Retrosigmoid approach

ASJC Scopus subject areas

  • Surgery
  • Clinical Neurology


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