Microvascular Decompression of the Vestibulocochlear Nerve for Disabling Positional Vertigo: The House Ear Clinic Experience

OBJECTIVE: To review characteristics of and outcome in patients undergoing microvascular decompression of the vestibulocochlear nerve. Patients studied had a diagnosis of disabling positional vertigo caused by a vascular loop compressing the VIIIth cranial nerve. STUDY DESIGN: Retrospective chart review and telephone interview. SETTING: Private practice tertiary neurotologic referral center. PATIENTS: Twenty patients with disabling positional vertigo underwent 25 retrosigmoid craniotomies for microvascular decompression between November 1990 and June 1999. The 4 men and 16 women ranged in age from 30 to 71 years (mean age, 46 yr). MAIN OUTCOME MEASURES: Charts were reviewed and patients were contacted by telephone and asked to rate severity of symptoms (tinnitus and dizziness) on a 4-point scale (none = 1, mild = 2, moderate = 3, and severe = 4) before and after surgery. They were also asked to rate their overall disability from their symptoms on the six-point scale established by the American Academy of Otolaryngology-Head and Neck Surgery. Preoperative and postoperative four-frequency (500 Hz, 1 kHz, 2 kHz, and 4 kHz) pure-tone average and speech discrimination scores were calculated and compared. Complications of surgery are also reported. RESULTS: Postoperative tinnitus score and dizziness score showed significant improvement from preoperative scores (p < or = 0.047 and p < or = 0.001, respectively), with 80% of patients improved in dizziness rating; 85% improved in their overall disability rating, and the difference from preoperative to postoperative was significant (p < or = 0.001). The mean postoperative pure-tone averages (15.4 dB) and speech discrimination scores (99%) did not differ from preoperative scores (11.9 dB and 98%). One patient lost all vestibular function in the operated ear (hearing remained intact) as the only complication of surgery. When asked, 83% of patients responded that they would have the surgery again. CONCLUSIONS: Diagnosing disabling positional vertigo secondary to vascular compression of the VIIIth cranial nerve remains the clinical challenge; a clear history plus air-contrast computed tomographic or magnetic resonance imaging make the diagnosis. Microvascular decompression of the vestibulocochlear nerve is a safe and effective operation for these carefully selected patients.