Craniotomy Procedure for Bilateral Meniere's Disease

Meniere's disease is a disorder that affects balance and hearing. Bilateral Meniere's disease occurs in both ears. If the patient suffers severe dizziness but still has good hearing, and drug therapy was ineffective, doctors will recommend a surgical procedure to cut the balance nerve between the brain and the inner ear. In order to gain access to the balance nerve, doctors perform a surgical procedure called a craniotomy. Understanding the craniotomy procedure requires a thorough understanding of the steps the doctor will take, as well as what will happen post-surgery as the patient recovers.

The procedure

• A craniotomy involves cutting a hole in the skull and removing a piece of the skull, called a bone flap, to gain access inside the skull. Nurses will prepare the scalp for surgery---this involves shaving the hair from the part of the scalp where the incision will occur (around the ear) and cleaning the area thoroughly. The surgeon will make an incision in the scalp, pull the scalp back and drill a hole in the skull, using the hole to cut out the bone flap. The surgeon saves the bone flap to replace when he is finished with the procedure. He then clips the vestibular nerve (the nerve that controls balance and connects the ear to the brain), replaces the bone flap---which he re-attaches using metal plates or special stitches---and pulls the scalp to normal position, stitching the incision closed.

  The procedure requires general anesthesia and usually involves four or five days in the hospital to monitor the patient through recovery.

Post-surgery expectations

• Understanding a craniotomy also involves knowing what will happen post-surgery. Although the procedure virtually eliminates all episodes of dizziness after a complete recovery, there will be occasional periods of unsteadiness for a few days after the surgery as the body compensates for the clipped nerve by relying on the opposite inner ear to detect balance. The doctor will likely recommend working with a physical therapist on a balance-building exercise program after release from the hospital as a precaution.

  Along with the usual slight risk of infection that accompanies any surgical procedure, there is also a risk that the patient will experience headaches after the surgery. The care team will work with the patient through the recovery period and afterward to manage any recurring side effects of the procedure.