If disabling vertigo persists in Meniere’s disease despite one or more treatments with Gentamicin perfusion of the inner ear, other more aggressive surgical alternatives exist. If hearing is still at a useful level, posterior fossa microsurgical vestibular neurectomy is highly successful at eliminating vertigo while allowing hearing preservation. The goal of the procedure is to cut the balance nerve between the inner ear and brainstem, which stops the brain from receiving abnormal impulses from the diseased inner ear.

The procedure is frequently performed by both a neurotologist and neurosurgeon. After the nerves are exposed near the brainstem, the surgeons must use high-powered magnification to identify the separation between the hearing and balance portions of the eighth cranial nerve. The balance (vestibular) nerve is selectively transected. After the surgery, the patient is kept in the hospital to recover for usually a 3-5 day period. Patients are expected to experience a short (1-2 day) period of vertigo, which is aggressively treated with medications. Prolonged imbalance may persist, which is usually effectively treated with vestibular therapy.

Vertigo cure rates have been excellent after vestibular neurectomy, with 93% of patients reporting that they are free of vertigo and would recommend the procedure to another patient. Hearing preservation rates have been excellent. Although vestibular neurectomy is an invasive neurosurgical type operation, complication rates have been minimal.