Transmastoid labyrinthectomy for disabling vertigo in a patient with internal auditory canal pathology.

OBJECTIVE

Document the use of transmastoid labyrinthectomy to treat disabling vertigo secondary to a lesion in the internal auditory canal.

PATIENT: A 69-year-old man with nonserviceable left hearing experienced disabling attacks of vertigo refractory to medical measures. Magnetic resonance imaging revealed a small left intracanalicular lesion with an irregular configuration and modest enhancement, suggesting either an unusual acoustic neuroma or a cavernoma. Tumor size remained stable on serial imaging, and the patient declined microsurgical resection, stereotactic radiation, or intratympanic gentamicin therapy.

INTERVENTION: Transmastoid labyrinthectomy followed by a customized vestibular rehabilitation program.

MAIN OUTCOME MEASURE: Comparison of patient symptoms preoperatively and at 5 and 8 months after surgery.

RESULTS

Complete relief of vertigo was achieved, but the patient has moderate imbalance postoperatively.

CONCLUSION

Transmastoid labyrinthectomy alone may be a viable treatment option in patients with an internal auditory canal neoplasm causing disabling attacks of vertigo.