Surgical treatment for vertigo is indicated when conservative management fails.Before surgery, it is necessary to confirm that the vertigo is of peripheral origin, and the diseased ear needs to be identified. In this symposium, I reviewed our experience on vestibular neurectomy for intractable vertigo attacks due to Meniere's disease and obliteration of vestibular aqueduct and encolymphatic sac for persistent positional vertigo in patients with large vestibular aqueduct syndrome (LVAS). Surgical procedures for vertigo are classified into two types;ablative and preservative procedures. Vestibular neurectomy is a typical ablative surgery for Meniere's disease, and vestibular aqueduct and endolymphatic sac obliteration surgery is a preservative procedure which we newly introduced to treat intractable positional vertigo in LVAS patients. Our results on vestibular neurectomy are satisfactory with excellent control of vertigo attacks and no patient with total hearing loss. Positional vertigo in LVAS patients disappeared with thetreated ear up head position, which improved the quality of life in our patients significantly. With appropriate indications and accurate surgical procedures, surgical treatment efficiently relieves vertigo and improve the patients' quality of life.
