Lateral semicircular canal plugging with endolymphatic sac decompression as new surgical treatment for intractable Meniere's disease

Objective: To investigate the symptomatic relief and functional preservation of a novel surgical strategy combined with triple semicircular canal occlusion and endolymphatic sac decompression in patients with intractable Meniere’s disease. Design: Retrospective analysis. Setting: Patients with intractable Meniere’s disease in the Department of Otolaryngology Head & Neck in the Second Affiliated Hospital of Nanchang University between July 2015 and June 2019. Participants: Data from 46 patients diagnosed with Meniere’s disease, and underwent surgery Methods: Triple semicircular canal occlusion combined with endolymphatic sac decompression was performed in all patients with intractable Meniere’s disease. Pre- and postoperative vertigo attacks, hearing levels, tinnitus, aural fullness, and equilibrium function rehabilitation were analyzed at defined time points during follow-up. Results: A significant vertigo control rate was observed in all patients postoperatively. The overall control rate of vertigo postoperatively was 100% in the entire follow-up, with a complete control rate of 97.8% and a substantial control rate of 2.2%. The rate of hearing preservation was 54.35%, and all patients suffering from hearing deterioration were at stages III and IV. The rate of tinnitus and aural fullness alleviation was 65.8% and 100%, respectively. Four patients failed to regain the equilibrium function postoperatively. Conclusion: Combining triple semicircular canal occlusion with endolymphatic sac decompression is an efficient strategy for vertigo control in patients with intractable Meniere’s disease. Patients in advanced stages suffered more from hearing function deterioration. Hearing preservation and tinnitus alleviation warrant further investigation.

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Endolymphatic Sac Surgery And Posterior Semicircular Canal Fenestration For Meniere’s Disease

PRILOZI ◽

10.2478/prilozi-2021-0012 ◽

2021 ◽

Vol 42 (1) ◽

pp. 141-148

Author(s):

Ilija S. Filipche ◽

Marina Davcheva Chakar ◽

Venko Filipche ◽

Sijavash Javari

Keyword(s):

Semicircular Canal ◽

Vestibular Function ◽

Meniere’S Disease ◽

Menière’S Disease ◽

Endolymphatic Sac ◽

Meniere's Disease ◽

Ménière’S Disease ◽

Menière's Disease ◽

Posterior Semicircular Canal ◽

Ménière's Disease

Abstract Objective: To evaluate the efficiency and safety of the simultaneous endolymphatic sac drainage (ELSD) and posterior semicircular canal fenestration (PSCF) primary on the vestibular function as an new therapeutic strategy in the patients with medically refractory Meniere’s disease (MD). Study Design: retrospective follow-up study. Setting: University Clinic of Otolaryngology. Methods: Twenty-six patients with MD with severe vertigo and disability who underwent ELSD and PSCF in the same time in the period of 1988 and 2007 were reviewed. The main outcome measures were frequency of vertigo, functional disability according the guidelines for diagnosis and evaluation of therapy in MD. The canal paresis was evaluated by caloric test. The degree of reduced vestibular response rates as an indicators of the vestibular function were compared before and after surgery. Results: The preoperative audition was already altered in all cases except in 8 patients who had no significant changes in hearing threshold. The mean value of vertigo attacks before operation was 8.6. After 3 years of surgery only one patient (3.8%) had one vertigo attack. Functional level was highly ameliorated except in two patients who presented functional level 2 or B in the late postoperative period. The mean caloric testing duration after 3 years postoperatively showed that the 50% of the patients approaching the normal results. Conclusion: Based on the results of simultaneous endolymphatic sac surgery and posterior canal fenestration, they are effective methods for treatment of the refractory Meniere’s disease. Endolymphatic sac surgery enables drainage of endolymphatic fluid and the fenestration of the posterior semicircular canal enables the distension or dilatation of the membranous canal in the decompressed perilymphatic space across the perilymphatic leak at the level of the new fenestra, and, so, appearing of certain decrease of the endolymphatic pressure. Both techniques at the same time decrease the pressure in the case of the endolymphatic hydrops.

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Endolymphatic sac surgical anatomy and transmastoid decompression of the sac for the management of Ménière's disease

The Journal of Laryngology & Otology ◽

10.1017/s0022215114001017 ◽

2014 ◽

Vol 128 (6) ◽

pp. 488-493 ◽

Cited By ~ 1

Author(s):

R R Locke ◽

J Shaw-Dunn ◽

B F O'Reilly

Keyword(s):

Semicircular Canal ◽

Meniere’S Disease ◽

Menière’S Disease ◽

Endolymphatic Sac ◽

Meniere's Disease ◽

Ménière’S Disease ◽

Surgical Trauma ◽

Menière's Disease ◽

Posterior Semicircular Canal ◽

Ménière's Disease

AbstractBackground:Decompression of the endolymphatic sac for Ménière's disease gives unpredictable results. This may be because the sac is difficult to identify and decompress accurately without causing surgical trauma.Methods:In order to test this idea, transmastoid decompression was simulated in 5 cadaver half heads and the anatomy of the endolymphatic sac was reviewed in a further 14 specimens.Results:The endolymphatic sac was found and confirmed by histology in all five simulated decompressions. A newly described feature, a trapezoid thickening of dura, was a useful guide. The review showed that the sac was constant proximally, but variable distally. The posterior semicircular canal, posterior fossa dura and sigmoid sinus are at risk during dissection.Conclusion:The endolymphatic sac may be identified on inspection by an overlying patch of dura, thereby reducing exploratory dissection. It is best to decompress the sac as far proximally as possible, whilst protecting the posterior semicircular canal.

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Occlusion of the Lateral Semicircular Canal Through the External Ear Canal: A Case Report

Ear Nose & Throat Journal ◽

10.1177/0145561320971951 ◽

2020 ◽

pp. 014556132097195

Author(s):

Enhao Wang ◽

Bo Liu ◽

Yi Wang ◽

Wei Yao ◽

Yu Sun

Keyword(s):

Case Report ◽

External Auditory Canal ◽

Semicircular Canal ◽

Meniere’S Disease ◽

Menière’S Disease ◽

Meniere's Disease ◽

Ménière’S Disease ◽

Menière's Disease ◽

Lateral Semicircular Canal ◽

Ménière's Disease

This case report introduces a novel surgical procedure to occlude the lateral semicircular canal through the external auditory canal. The patient was a 64-year-old male with Ménière’s disease who had suffered from left ear vertigo accompanied by tinnitus for more than 4 years. He also suffered from paroxysmal vertigo, fluctuating hearing loss, tinnitus symptoms, and ear distension and tightness. The patient had been treated with dexamethasone injected into the tympanic cavity for 1 year, but his condition often recurred and could not be controlled. We developed a novel procedure using an endoscope to occlude the lateral semicircular canal through the external auditory canal to provide a surgical option for the treatment of Ménière's disease.

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Triple Semicircular Canal Occlusion Combined with Endolymphatic Sac Decompression: An Effective Surgical Strategy for Vertigo Control of Intractable Meniere's Disease

Clinical Otolaryngology ◽

10.1111/coa.13852 ◽

2021 ◽

Author(s):

Bingbin Xie ◽

Meiqun Wang ◽

Yunxia Jiang ◽

Wen Xie ◽

Shaorong Zhang ◽

...

Keyword(s):

Semicircular Canal ◽

Meniere’S Disease ◽

Menière’S Disease ◽

Surgical Strategy ◽

Endolymphatic Sac ◽

Meniere's Disease ◽

Ménière’S Disease ◽

Menière's Disease ◽

Ménière's Disease ◽

Semicircular Canal Occlusion

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Vestibular Endolymphatic Hydrops Visualized by Magnetic Resonance Imaging and Its Correlation With Vestibular Functional Test in Patients With Unilateral Meniere's Disease

Frontiers in Surgery ◽

10.3389/fsurg.2021.673811 ◽

2021 ◽

Vol 8 ◽

Author(s):

Yupeng Liu ◽

Fan Zhang ◽

Baihui He ◽

Jingchun He ◽

Qing Zhang ◽

...

Keyword(s):

Semicircular Canal ◽

Meniere’S Disease ◽

Menière’S Disease ◽

Head Impulse Test ◽

Caloric Test ◽

Meniere's Disease ◽

Ménière’S Disease ◽

Menière's Disease ◽

Lateral Semicircular Canal ◽

Ménière's Disease

Background: Currently, 3 Tesla-MRI following intratympanic gadolinium injection has made it possible to assess the existence and the severity of hydrops in each compartment of the endolymphatic spaces in vivo. However, the relationship between vestibular endolymphatic hydrops (EH) visualized by MRI and vestibular functional tests, especially the correlation between caloric test, video-head impulse test, and semicircular canal hydrops, has not been well-investigated.Objective: The purpose of this study is to investigate the relationship between the severity of EH in each compartment of otoliths and semicircular canal and the results of vestibular functional tests.Methods: In this retrospective study, we performed three-dimensional fluid-attenuated inversion recovery (3D-FLAIR) sequences following intratympanic gadolinium injection in 69 unilateral patients with definite Menière's disease. Vestibular and lateral semicircular canal hydrops was graded on MRI using a four grade criterion. All patients underwent pure-tone audiometry, cervical vestibular evoked myogenic potential (cVEMP), ocular vestibular evoked myogenic potential (oVEMP), caloric test and video head impulse test (vHIT). The latency, amplitude and asymmetry ratio of VEMP, canal paresis (CP) and vestibulo-ocular reflex (VOR) gain of lateral semicircular canal of vHIT were collected. The correlation analysis were performed between the parameters of function test and EH.Results: Vestibular EH showed correlations with the duration of disease (r = 0.360) and pure tone average (r = 0.326). AR of cVEMP showed correlations with Vestibular EH (r = 0.407). CP (r = 0.367) and VOR gain of lateral semicircular canal at 60 ms (r = 0.311) showed correlations with lateral semicircular canal hydrops.Conclusion: EH in different compartments is readily visualized by using 3D-FLAIR MRI techniques. The degree of vestibular EH correlated with AR of cVEMP and EH in the semicircular canal ampullar affects the caloric and vHIT response in patients with unilateral Meniere‘s disease.

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