Microvascular decompression of the VIII cranial nerve for the treatment of refractory tinnitus and paroxysmal vertigo – A case series

Background: Tinnitus is a common otologic complaint, affecting 10-15% of the general population, with 5% of patients developing disabling symptoms refractory to pharmacological therapy. Neurovascular compression of the VIII cranial nerve has been proposed as a potential etiology, and microvascular decompression (MVD) may represent a therapeutic alternative. Methods: We present a case series of seven patients with disabling tinnitus, vertigo, and, in some cases, hypoacusis, all of whom were refractory to at least 12 months of pharmacological treatment. Preoperative assessment included audiometry and high-resolution magnetic resonance imaging (fast imaging employing steady-state acquisition sequence), which confirmed a vascular loop contacting the VIII cranial nerve. Patients underwent retrosigmoid MVD, with follow-up ranging from 1 to 10 months. Results: Five patients (72%) achieved complete resolution of tinnitus and vertigo, while two patients (28%) reported >80% improvement. One patient developed transient House-Brackmann III facial palsy that resolved with steroids. No cases of permanent hearing loss, cerebrospinal fluid leak, or vascular complications were observed. Quality of life scores improved significantly postoperatively. The most common offending vessel was the anterior inferior cerebellar artery. Conclusion: MVD of the VIII cranial nerve is a safe and effective therapeutic option in selected patients with refractory tinnitus and vertigo, achieving substantial symptomatic improvement with a low complication rate. Larger prospective studies are warranted to validate these findings and establish long-term outcomes.