Ventriculoperitoneal shunt insertion for the treatment of refractory perilymphatic fistula.

OBJECT

The goal of this study was to provide preliminary data regarding clinical and functional outcome, including postoperative morbidity, related to ventriculoperitoneal (VP) shunt insertion for refractory perilymphatic fistula.

METHODS

The authors retrospectively reviewed the records of seven consecutive patients who had undergone VP shunt insertion for medically and surgically refractory perilymphatic fistula between 1996 and 2004. Patients were also contacted by telephone and asked to assess retrospectively their symptomatic improvement, changes in functional status, and changes in work status following shunt placement. Preoperative and postoperative functional statuses were assessed using a standardized instrument. In each patient, preoperative opening pressure was measured via lumbar puncture. Pressures ranged from 160 to 300 mm H2O, with a mean of 241 mm H2O. All patients reported significant improvement in symptom severity following surgery. Two patients reported complete resolution of symptoms. Three patients were able to resume full-time work. Clinically significant improvement in functional status was noted in six of seven patients. All patients would recommend the procedure to others in a similar situation.

CONCLUSIONS

Data in this study suggest that some patients with disabling vertigo, tinnitus, and headache due to perilymphatic fistula, whose conventional medical and surgical therapies have failed to produce a cure, benefit from VP shunt insertion. The authors hypothesize that VP shunt placement blunts intracranial pressure increases, which would cause secondary elevations in perilymphatic fluid pressure. Shunt insertion reduces perilymph leakage into the middle ear and may permit closure of the fistula.