Combined retrolab-retrosigmoid vestibular neurectomy. An evolution in approach

Since introducing the retrolabyrinthine vestibular neurectomy (RVN) in 1978, we have performed 78 procedures with good results. In 1985, we introduced the retrosigmoid-internal auditory canal vestibular neurectomy (RSG-IAC), which allowed a more complete transection of the vestibular nerves in the IAC. Vertigo control has been excellent. However, in 50% of cases postoperative headaches have been a significant problem. In 1987, we combined these two approaches into one procedure, the combined retrolab-retrosigmoid vestibular neurectomy (RSG-RVN). The procedure is similar to a RVN, in that all bone covering the lateral venous sinus (LVS) is removed. It differs from the RVN in that the dura is opened just behind the LVS. The LVS is retracted forward, thereby exposing the cerebellopontine (CP) angle. This allows the surgeon the option to sever the vestibular nerve either in the CP angle or in the IAC, depending on the presence or absence of a cochleovestibular (CV) cleavage plane in the CP angle. The technique, results, and complications will be reported in this article.