Title

Transcanal endoscopic infracochlear vestibular neurectomy: A pilot cadaveric study

UMMS Affiliation

Department of Otolaryngology; School of Medicine; Senior Scholars Program

Faculty Mentor

Aaron Remenschneider

Publication Date

2018-11-01

Document Type

Article

Disciplines

Medical Education | Nervous System Diseases | Otolaryngology | Otorhinolaryngologic Diseases

Abstract

PURPOSE: Effective operative approaches for the treatment of refractory vertigo in Meniere's disease are invasive. Vestibular neurectomy can preserve hearing and has been shown to be effective; however, current approaches require an extensive craniotomy. Transcanal endoscopic approaches to the internal auditory canal (IAC) with cochlear preservation have been recently described and may offer a minimally invasive approach to selectively sectioning the distal vestibular nerves while preserving residual hearing.

MATERIALS AND METHODS: Three cadaveric human heads were imaged using high resolution computed tomography (CT). Anatomic analysis of preoperative CT scans showed adequate diameters ( > 3mm) of the infracochlear surgical corridor for access to the IAC. A transcanal endoscopic approach was attempted to section the vestibular nerve. Post-operative CT scans were assessed to define the operative tract, determine cochlear preservation and assess cochlear and facial nerve preservation.

RESULTS: Transcanal endoscopic approach was successfully performed (n=3) using 3mm-diameter, 14cm-length 0 degrees , 30 degrees , and 45 degrees endoscopes and microsurgical drills. In all cases the tympanomeatal flap and ossicular chain remained intact. Internal auditory canalotomy was performed using angled instruments and confirmed in real time via lateral skull base navigation. The vestibular nerves were readily identified and sectioned with preservation of the facial and cochlear nerves. Post-procedure CT showed no violation of the cochlea.

CONCLUSION: A transcanal, infracochlear approach to the IAC may permit a minimally invasive approach to distal vestibular neurectomy in cadavers with appropriate anatomy.

Keywords

Meniere's disease, Transcanal endoscopy, Vestibular neurectomy

DOI of Published Version

10.1016/j.amjoto.2018.07.024

Source

Trakimas DR, Kempfle JS, Reinshagen KL, Lee DJ, Kozin ED, Remenschneider AK. Transcanal endoscopic infracochlear vestibular neurectomy: A pilot cadaveric study. Am J Otolaryngol. 2018 Nov-Dec;39(6):731-736. doi: 10.1016/j.amjoto.2018.07.024. Epub 2018 Aug 1. PMID: 30104073. Link to article on publisher's site

Journal/Book/Conference Title

American journal of otolaryngology

Comments

Danielle Trakimas participated in this study as a medical student in the Senior Scholars research program at the University of Massachusetts Medical School.

Related Resources

Link to Article in PubMed

PubMed ID

30104073

Link to Full Text

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