Revision surgery after saccotomy for Meniere's disease: does it make sense?

Abstract

Saccotomy is an established surgical treatment for Meniere's disease that involves exposing and opening the endolymphatic sac and draining the endolymph. However, in patients experiencing recurrent vertigo after saccotomy, it is questionable whether revision saccotomy should be recommended as opposed to more invasive procedures, such as neurectomy of the vestibular nerve. To determine the utility of revision saccotomy, we conducted a retrospective study of 29 patients undergoing this procedure for recurrent vertigo. Patient charts were reviewed for the re-occurrence of any vertiginous symptoms and outcomes with regard to hearing results and post-operative complications. An attempt was made to correlate vertigo status post-revision with surgical findings at the time of revision. After an average follow-up of 20 months, 18 patients (62%) were free of vertigo, and four patients (14%) had a significant decrease in the frequency and intensity of vertiginous attacks. Two patients (7%) relapsed after a vertigo-free period of 18 months, and five patients (17%) experienced no clinical improvement after revision surgery. In patients with a successful sac revision, a common finding at the time of revision was new bone formation in the endolymphatic sac area (n=11), which may have caused blocking of the endolymphatic drainage. Our results demonstrate that revision saccotomy should be considered for recurrent Meniere disease before other, more invasive, surgical options.

Study of Vestibular Evoked Myogenic Potentials in Patients Affected by Meniere's Disease Treated with Endolymphatic Mastoid Shunt

“…The procedure does not exclude the possibility of revision or destructive surgery in the case of unsuccessful results. 19 Further studies are needed to confirm our results. The aim of our work was to understand the mechanisms that underlie the beginning and course of MD and its response to different medical and surgical treatments.…”

Intratympanic gentamicin treatment after endolymphatic sac surgery

“…However, saccotomy is still performed and even revision saccotomy of the endolymphatic sac [6], as an alternative to vestibular nerve section [7], or labyrinthectomy, in cases of concurrent nonserviceable sensorineural hearing loss [8], have been used as treatment options after failure of an initial saccotomy to control MAIV. Revision saccotomy completely controlled vertigo spells in 62% of patients with MAIV and decreased the frequency and intensity of the vertigo attacks in 14% after an average follow-up period of 20 months following an initial saccotomy procedure [6]. After 18 months, vertigo had recurred in 7% of these patients, and another 17% showed no improvement at all after revision saccotomy.…”

Die Saccotomie in der Behandlung des M. Ménière: Beurteilung der kurz-, mittel- und langfristigen Ergebnisse anhand eines Patientenfragebogens

“…Aller-dings wurden lediglich 9 Patienten (6 % ) aus unserer Serie ü ber einen Zeitraum von ü ber 6 Jahren nachbeobachtet, sodass die hohen Spontanremissionsraten bei sehr langen Krankheitsverl ä ufen hier eine untergeordnete Rolle spielen. Die Annahme der Wirksamkeit der Saccotomie wird auch durch die in unserer Klinik gemachten Erfahrungen mit Revisionsoperationen unterst ü tzt [32] . Es zeigte sich hierbei, dass bei einer Mehrzahl der Patienten, die eine erfolgreiche Revision erhielten, Ursachen f ü r die erfolglose Drainage gefunden werden konnten.…”