Vestibular neurectomy with simultaneous endolymphatic subarachnoid shunt

The purpose of this study was to assess the advantages of combined vestibular neurectomy (VN) and endolymphatic subarachnoid shunt (ELSS) surgeries in classic Menière's disease. We performed a retrospective analysis of the results of 116 patients with classic Menière's disease who were operated on via a posterior fossa approach. All patients underwent selective VN. In 86 of the patients, ELSS surgery was performed in conjunction with VN via the posterior fossa, which is called two-in-one surgery. Among the 86 patients who underwent two-in-one surgery, hearing preservation was achieved in 71 (82.5%), and the vertigo control rate was 96.5%. In patients who underwent VN without ELSS, hearing stabilization was achieved in 24 (80%), and the vertigo control rate was 96.7%. The hearing results and vertigo control rates were similar in the groups. Aural fullness subsided in 62 (72.1%) of the patients who underwent VN plus ELSS and in 14 (46.7%) who underwent VN alone. The recovery of fullness was significantly better with the combined VN and ELSS procedure (P<0.05). In conclusion, although the two-in-one operation is a new procedure, its results for vertigo control and hearing stabilization are not different from that of VN alone. The only significant advantage of this technique was the achievement of a substantial improvement in the reduction of aural fullness.