Issue N# 1 - 2018
OTONEUROLOGY
Singular neurectomy for refractory BPPV indications and results
Authors : Lorin P, Collinet P. (Le Mans)
Ref. : Rev Laryngol Otol Rhinol. 2018;139,1:3-6.
Article published in english 
Downloadable PDF document english
Summary :
Objectives: To describe indications, surgical technique, complications and results to the singular neurectomy in posterior canal BPPV. Material: 11 patients operated between 2008 and 2014 with an intractable posterior canal BPPV. Method: Each patient received a pre and a post-operative (at one week, one month, one year) functional assessment, including symptomatic scales, positional videonystagmography 3 dimensions, subjective visual vertical, Rod and Frame test, pure-tone audiometry. Video head impulse was practice only after the surgery. Results: The average age was 44.18 years. Before the intervention, the pre-surgical monitoring had lasted 13.45 months on average, during which the patients had received an average number of 10.36 maneuvers. The operating time was 112.27 minutes on average. With practice, this duration considerably decreased. Patients were able to walk and leave hospital after 2.36 days on average. The complications were: 1 case of cophosis (9.09%) and 1 case of afterward tympanic perforation (9.09%). After surgery, all our patients recovered from their BPPV. However, from a symptomatic point of view, the enhancement measured with the symptomatic scales hardly reached 36.5%. One year after, all our patients compensated their deafferented spontaneous nystagmus, however when in position of Hallpike either on the right or on the left side, all of them were affected by a torsional nystagmus ipsilateral to the operated side. The high frequency gain of the operated canal evaluated by the VHIT was in average: 0.33. Conclusion: All of our patients have recovered from their BPPV after the singular neurectomy, but in the light of this study we don’t recommend to apply this surgical technique. The singular neurectomy is more difficult to practice than the canal plugging for a neurotologist moreover the cophosis risk is consequent. If this surgery decreases positional vertigo it creares visual vertigo.
Price : 12.00 €
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