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. 2022 Sep 16:13:418.
doi: 10.25259/SNI_187_2022. eCollection 2022.

Endolymphatic duct and sac decompression: A new technique for Ménière's disease treatment

Fabrizio Salvinelli  1   2 , Francesca Bonifacio  1 , Fabio Greco  1 , Giulio Cavicchioni  1 , Valeria Frari  1 , Michelangelo Pierri  1 , Maurizio Trivelli  1 , Maurizio Iacoangeli  3
Affiliations

Endolymphatic duct and sac decompression: A new technique for Ménière's disease treatment

Fabrizio Salvinelli et al. Surg Neurol Int. .

Abstract

Background: The present article aims to introduce the endolymphatic duct and sac decompression technique (DASD) and to give a spotlight on its benefits in Ménière's disease (MD) treatment.

Methods: Eighty-two patients with intractable MD which met the inclusion criteria were recruited and underwent DASD. This technique allows a meningeal decompression of the duct and the sac from the posterior cranial fossa to the labyrinthine block. The authors considered as main outcomes, the change of the dizziness handicap inventory (DHI) results, with the evaluations of the three sub-scales (Functional scale, Physical scale, and Emotional scale); ear fullness and tinnitus change on the perceptions of the patient; and hearing stage with four-Pure Tone Average (500 hz-1000 hz-2000 hz-4000 hz). The differences between the preoperative and the postoperative score were evaluated. A comparison with the literature was conducted.

Results: After a 14-month follow-up, patients that underwent DASD reported a remarkable improvement of the symptoms in all three functional scales, confirmed by the total DHI. The difference between preoperative and postoperative scores is statistically significant. The data describe an ear fullness and tinnitus improvement. The multi-frequency tonal average before and after the surgery does not suggest a worsening of the value for any of 82 patients.

Conclusion: The modification of sac surgery includes the endolymphatic duct in the decompression area allowing inner ear functional improvement, vertigo control, ear fullness improvement with minimal risk of facial nerve paralysis, and hearing loss. DASD is an improved old surgical technique.

Keywords: Endolymphatic decompression; Endolymphatic hydrops; Ménière’s disease; Vertigo.

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Conflict of interest statement

There are no conflicts of interest.

Figures

Figure 1:
Figure 1:
Decompression zone, BP: bone pate, PSC: posterior semicircular canal, D: dura mater, SS: sigmoid sinus, and ES: endolymphatic sac.
Figure 2:
Figure 2:
(a and b) Demonstration of endolymphatic duct decompression.
Figure 3:
Figure 3:
Comparison of total dizziness handicap inventory for each patient before and after surgery.
Figure 4:
Figure 4:
Four Pure Tone average (500 Hz-1000 Hz-2000 Hz-4000 Hz) before and after surgery.
See this image and copyright information in PMC

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