Microvascular decompression for tinnitus: systematic review

Abstract

OBJECTIVE The objective of this study was to examine operative outcomes in cases of microvascular decompression (MVD) of cranial nerve (CN) VIII for tinnitus through a critical review of the literature. METHODS Forty-three English-language articles were gathered from PubMed and analyzed. In this review, two different case types were distinguished: 1) tinnitus-only symptomatology, which was defined as a patient with tinnitus with or without sensorineural hearing loss; and 2) mixed symptomatology, which was defined as tinnitus with symptoms of other CN dysfunction. This review reports outcomes of those with tinnitus-only symptoms. RESULTS Forty-three tinnitus-only cases were found in the literature with a 60% positive outcome rate following MVD. Analysis revealed a 5-year cutoff of preoperative symptom duration before which a good outcome can be predicted with 78.6% sensitivity, and after which a poor outcome can be predicted with 80% specificity. CONCLUSIONS As the 60% success rate is more promising than several other therapeutic options open to the chronic tinnitus sufferer, future research into this field is warranted.

Keywords: AAO-HNS = American Academy of Otolaryngology–Head and Neck Surgery; CBT = cognitive behavioral therapy; CN = cranial nerve; CPA = cerebellopontine angle; FIESTA = fast imaging employing steady-state acquisition; HFS = hemifacial spasm; MVD = microvascular decompression; NVC = neurovascular compression; ROC = receiver operating characteristic; SNHL = sensorineural hearing loss; TN = trigeminal neuralgia; functional neurosurgery; microvascular decompression; retrosigmoid craniotomy; tinnitus.