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Episodic vertigo is a serious disabling condition. Unexpected attacks of rotatory vertigo accompanied by nausea and vomiting are significant disorders substantially alerting the quality of life. The case majority of dizziness and vestibular disease is self-limited and can be managed successfully with medications and conservative therapy. The rationale for vestibular nerved section is based upon the physiology of normal vestibular function and central compensation to peripheral vestibular injury. The vestibular system functions by providing tonic output from both inner ears altering the central nervous system to static position and head movements in roatory or vertical directions. A sudden change in vestibular output form on ear results in a sensory mismatch. The patient is left with the illusion of significant unilateral vestibular stimulation resulting in a sensation of vertigo in the case of unilateral vestibular ablation, the central mechanism for compensation relies on the “cerebellar clamp” to decrease tonic output from the unaffected side and gradually restore baseline vestibular output though a complex mechanism of neurochemical modulation and neuronal plasticity Central compensation is impaired in situations involving fluctuating vestibular injury. The conceptual basis for vestibular nerve section is to convert a partial or fluctuating vestibular injury into a fixed, nonfluctuating situation permitting central compensation though the unaffected side. This lesson discusses the indications and techniques of selective vestibular nerve section. It should be emphasized that this treatment modality is restricted to patients who have failed aggressive application of medications and nondestructive surgical strategies for the treatment of vertigo.
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