Transcanal endoscopic infracochlear vestibular neurectomy: A pilot cadaveric study
Department of Otolaryngology; School of Medicine; Senior Scholars Program
Medical Education | Nervous System Diseases | Otolaryngology | Otorhinolaryngologic Diseases
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.
Meniere's disease, Transcanal endoscopy, Vestibular neurectomy
DOI of Published Version
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
American journal of otolaryngology
Trakimas, Danielle R.; Kempfle, Judith S.; Reinshagen, Katherine L.; Lee, Daniel J.; Kozin, Elliott D.; and Remenschneider, Aaron K., "Transcanal endoscopic infracochlear vestibular neurectomy: A pilot cadaveric study" (2018). University of Massachusetts Medical School. Senior Scholars Program. Paper 283.