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Microvascular decompression of the cochleovestibular nerve for treatment of tinnitus and vertigo: a systematic review and meta-analysis of individual patient data

van den Berge, M. J. C., van Dijk, J. M. C., Posthumus, I. A., Smidt, N., van Dijk, P. & Free, R. H., Sep-2017, In : Journal of Neurosurgery. 127, 3, p. 588-601 14 p.

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  • Microvascular decompression of the cochleovestibular nerve for treatment of tinnitus and vertigo a systematic review and meta-analysis of individual patient data

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DOI

OBJECTIVE Microvascular decompression (MVD) is regarded as a valid treatment modality in neurovascular conflicts (NVCs) causing, for example, trigeminal neuralgia and hemifacial spasms. An NVC of the cochleovestibular nerve might cause tinnitus and/or vertigo; however, general acceptance of MVD for this indication is lacking. The aim of this study was to investigate the effectiveness, safety, and prognostic factors for success of MVD of the cochleovestibular nerve.

METHODS A systematic review and meta-analysis of individual patient data (IPD) were conducted according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses and Individual Patient Data (PRISMA-IPD) guidelines. By a comprehensive search (conducted in January 2016) in MEDLINE, EMBASE, and Google Scholar, eligible studies were identified. The collected outcome was a global measurement of improvement of 1) tinnitus, 2) vertigo, and 3) tinnitus combined with vertigo. For the meta-analysis, IPD were collected from the papers and/or from the authors. IPD were analyzed with logistic regression analysis while accounting for study clustering.

RESULTS Thirty-five studies (572 patients) were included. The level of evidence provided by these studies was low. In 28% of patients with tinnitus and 32% of patients with vertigo, complete relief following MVD was reported. Patients with both tinnitus and vertigo had complete relief in 62% of cases. In 11% of patients, >= 1 complications were reported. Meta analysis of IPD (165 patients) demonstrated that patients with both tinnitus and vertigo had a higher chance of success (OR 3.8, 95% CI 1.45-10.10) than patients with tinnitus alone. No other variables were significantly related to success.

CONCLUSIONS Due to low success rates, MVD cannot be considered as a standard treatment method for tinnitus or vertigo. Moreover, a substantial complication rate was found. However, patients with combined symptoms had a higher chance of success. When combined symptoms occur, it is more likely that an NVC is the underlying pathology and MVD might be appropriate. Due to the low level of evidence in the included studies, this conclusion must be taken with caution. Further validation is necessary to evaluate whether patients with combined symptoms are indeed better candidates for MVD.

Original languageEnglish
Pages (from-to)588-601
Number of pages14
JournalJournal of Neurosurgery
Volume127
Issue number3
Early online date2-Dec-2016
Publication statusPublished - Sep-2017

    Keywords

  • cochleovestibular nerve, microvascular decompression, neurovascular conflict, tinnitus, vertigo, functional neurosurgery, 8TH CRANIAL NERVE, DISABLING POSITIONAL VERTIGO, NEUROVASCULAR COMPRESSION SYNDROMES, VASCULAR-DECOMPRESSION, COCHLEAR NERVE, TYPEWRITER TINNITUS, SELECTION CRITERIA, PARTICIPANT DATA, SYMPTOMS, SURGERY

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