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.