Ch33 Neurootology Flashcards
What is Dandy’s syndrome?
Bilateral vestibular hypo function and oscillopsia (due to bilateral vestibular failure e.g. bilateral sectioning of vestibular nerve)
What surgical treatment should be considered available for disabling positional vertigo?
Microvascular decompression of the vestibular nerve
How can you identify the vestibular nerve in the facioacoustic bundle?
It’s in the superior half and is more gray
Can be separated by a small vessel or an indentation in the bundle
What are the two most common indications for selective vestibular neurectomy?
Meniere’s
Partial vestibular injury (viral or traumatic)
What are the three surgical approaches for selective vestibular neurectomy?
Retrolabyrinthine Retrosigmoid Middle Fossa (extradural)
What is the clinical triad of Menieres?
Vertigo
Tinnitus
Fluctuating Low Frequency Hearing Loss
What’s the cause of Menieres?
Increased endolympathic pressure
What would you expect to see on CT and MRI in Menieres?
Normal scan
What’s the difference between House-Brackman 3 and 4 at the forehead?
3 - slight to moderate movement
4 - no movement
What’s the difference between House-Brackman 3 and 4 at the eye?
3 - complete closure with effort
4 - incomplete closure
What’s the difference between House-Brackman 3 and 4 at the mouth?
3 - slightly weak with maximal effort
4 - asymmetry with maximal effort
What’s the treatment of peripheral facial palsy? (Bell’s palsy is idiopathic peripheral facial palsy)
Eye protection
Steroids (for 10 days) +/- acyclovir
Surgical decompression - controversial
What are the surgical options for reconstructing an intracranial facial nerve section at surgery?
Direct reanastamosis Cable graft (e.g. greater auricular nerve or sural nerve)
What are the surgical options for extracranial facial nerve reconstruction?
Hypoglossal anastomosis Spinal accessory anastamosis Phrenic nerve anastomossi Glossopharyngeal anastomsis VII VII grafting (cross-face
What are the non nerve options to treat CN VII palsy?
Facial suspension Eye closure with - Tarsorrhapy - gold weights - spring in eyelid
