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

Locke, Richard; Shaw-Dunn, John; O’Reilly, Brian F.

doi:10.1017/s0022215114001017

Cited by 7 publications

(16 citation statements)

References 13 publications

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“…Although endolymphatic sac surgery has been established since 1927, this ambiguity about the effectiveness of surgical intervention in the form of ESD still exists ( 21 – 23 ). Locke ( 24 ) reported that the unpredictability of the outcomes of surgical decompression might be related to the difficulty in locating and fully decompressing the endolymphatic sac. Moreover, prolonged exploration of the cystic region may increase the risk of complications due to damage to the cystic cavity and its surrounding structures.…”

Section: Discussionmentioning

confidence: 99%

“…Moreover, prolonged exploration of the cystic region may increase the risk of complications due to damage to the cystic cavity and its surrounding structures. Locke recommended that bone should be removed from the superior petrosal sinus to the jugular bulb and from a point medial to the posterior semicircular canal and posterior to the sigmoid sinus ( 24 ). The endolymphatic sac was located by measuring the lower limit of the posterior semicircular canal and maintained outside the posterior semicircular canal for decompression in LESD.…”

Section: Discussionmentioning

confidence: 99%

“…However, anatomical measurements showed that this was the most variable part. Therefore, decompression limited to this area to reach the endolymphatic sac is unlikely to be reliable ( 24 ). Paparella et al ( 25 ) reported that high vertigo control was achieved through wide decompression of the endolymphatic sac and posterior fossa, such as the sigmoid sinus, the jugular bulb, and middle fossa in the study.…”

Section: Discussionmentioning

confidence: 99%

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A Comparison of Local Endolymphatic Sac Decompression, Endolymphatic Mastoid Shunt, and Wide Endolymphatic Sac Decompression in the Treatment of Intractable Meniere's Disease: A Short-Term Follow-Up Investigation

Zheng

Liu

et al. 2022

Front. Neurol.

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BackgroundMeniere's disease (MD) is an inner ear disorder, characterized by recurrent attacks of vertigo, low-frequency sensorineural hearing loss, tinnitus, and aural fullness. Endolymphatic sac surgery is an effective treatment to control vertigo attacks but without causing a hearing loss for intractable MD. However, the methods and effects of endolymphatic sac surgery have been controversial for many years, and the relationship between the vertigo control rates of different endolymphatic sac surgery methods is not well-documented.ObjectivesThis study compared the vertigo control rate, hearing outcome, and quality of life (QOL) among different endolymphatic sac surgery, such as local endolymphatic sac decompression (LESD), endolymphatic sac mastoid shunt (ESMS), and wide endolymphatic sac decompression (WESD).Materials and MethodsWe retrospectively analyzed the patients who underwent endolymphatic sac surgery from January 2008 to June 2019. The control rate of vertigo and QOL scores were compared after 2 years of follow-up. The QOL was scored with validation of the MD patient-oriented symptom-severity index (MDPOSI). The pure tone thresholds of all patients at pre- and postoperation were also compared.ResultsIn total, 83 MD patients with complete follow-up data were included in the study, i.e., 20 patients with LESD, 28 patients with ESMS, and 35 patients with WESD. Results showed a better vertigo control with WESD than the other groups (70% with LESD, 71.4% with ESMS, and 88.6% with WESD). The QOL was improved after surgery in all groups in which the difference was statistically significant (QOL, preoperative vs. postoperative, 38.2 vs. 10.1 with LESD, 37.8 vs. 9.6 with ESMS, and 37.6 vs. 8.3 with WESD), respectively. After endolymphatic sac surgery, the hearing was well-preserved in the three groups [pure tone averages (PTAs), dB, preoperative vs. postoperative, 41.0 ± 19.3 vs. 40.8 ± 17.9 with LESD, 39.7 ± 16.4 vs. 40.8 ± 18.2 with ESMS, and 38.5 ± 18.7 vs. 36.6 ± 19.5 with WESD].ConclusionWide endolymphatic sac decompression has a higher vertigo control rate, better improvement of QOL, and relatively higher hearing stability or improvement rate after surgery in patients with MD compared with LESD and ESMS.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

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A Comparison of Local Endolymphatic Sac Decompression, Endolymphatic Mastoid Shunt, and Wide Endolymphatic Sac Decompression in the Treatment of Intractable Meniere's Disease: A Short-Term Follow-Up Investigation

Zheng

Liu

et al. 2022

Front. Neurol.

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“…In a 2014 anatomical study of the temporal bone, Locke et al32 explained that one possible reason for the inconsistent results obtained with endolymphatic sac surgeries is that the sac itself is difficult to identify and a proper decompression is not often accomplished, much less a proper drainage. The reason for this is that the intradural component of the sac varies in size and position.…”

Section: Review Of the Literaturementioning

confidence: 99%

Endolymphatic Sac Surgery for Ménière's Disease – Current Opinion and Literature Review

García

Segura

Lesser

et al. 2017

Int Arch Otorhinolaryngol

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Introduction The endolymphatic sac is thought to maintain the hydrostatic pressure and endolymph homeostasis for the inner ear, and its dysfunction may contribute to the pathophysiology of Ménière's disease. Throughout the years, different surgical procedures for intractable vertigo secondary to Ménière's disease have been described, and though many authors consider these procedures as effective, there are some who question its long-term efficacy and even those who think that vertigo control is achieved more due to a placebo effect than because of the procedure itself. Objective To review the different surgical procedures performed in the endolymphatic sac for the treatment of Ménière's disease. Data Sources PubMed, MD consult and Ovid-SP databases. Data Synthesis We focus on describing the different surgical procedures performed in the endolymphatic sac, such as endolymphatic sac decompression, endolymphatic sac enhancement, endolymphatic sac shunting and endolymphatic duct blockage, their pitfalls and advantages, their results in vertigo control and the complication rates. The senior author also describes his experience after 30 years of performing endolymphatic sac surgery. Conclusions The endolymphatic sac surgery, with all its variants, is a good option for patients with incapacitating endolymphatic hydrops, providing a high percentage of vertigo control and hearing preservation.

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“…Endolymphatic sac surgery is a contentious issue in Ménière's disease treatment. In the current issue, Locke and colleagues describe the surgical anatomy of the endolymphatic sac and suggest that the results of surgical decompression may be unpredictable because the sac is difficult to locate and decompress adequately 2 . In another ‘pressure-related’ otological article, Mitchell-Innes and colleagues discuss air travellers' awareness of the preventability of otic barotrauma 3 .…”

mentioning

confidence: 99%

The ear under pressure

Youngs¹,

Fisher²

2014

J. Laryngol. Otol.

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This issue of The Journal of Laryngology & Otology has more of a focus on otology. The Archives of The Journal have a wealth of information going back in time to the journal's inception in 1887. A recent article by Flood and Kenyon reviewed The Journal's archive material on Ménière's disease, 1 including an early description of endolymphatic sac surgery in 1927. Endolymphatic sac surgery is a contentious issue in Ménière's disease treatment. In the current issue, Locke and colleagues describe the surgical anatomy of the endolymphatic sac and suggest that the results of surgical decompression may be unpredictable because the sac is difficult to locate and decompress adequately. 2 In another 'pressure-related' otological article, Mitchell-Innes and colleagues discuss air travellers' awareness of the preventability of otic barotrauma. 3 Air travel is increasingly common, and it appears that although the majority of

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

Abstract: 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.

Cited by 7 publications

References 13 publications

A Comparison of Local Endolymphatic Sac Decompression, Endolymphatic Mastoid Shunt, and Wide Endolymphatic Sac Decompression in the Treatment of Intractable Meniere's Disease: A Short-Term Follow-Up Investigation

A Comparison of Local Endolymphatic Sac Decompression, Endolymphatic Mastoid Shunt, and Wide Endolymphatic Sac Decompression in the Treatment of Intractable Meniere's Disease: A Short-Term Follow-Up Investigation

Endolymphatic Sac Surgery for Ménière's Disease – Current Opinion and Literature Review

The ear under pressure

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