Locke R R, Shaw-Dunn J, O'Reilly B F
Department of Anatomy,University of Glasgow,Glasgow,Scotland,UK.
Institute of Neurological Sciences,Southern General Hospital,Glasgow,Scotland,UK.
J Laryngol Otol. 2014 Jun;128(6):488-93. doi: 10.1017/S0022215114001017. Epub 2014 Jun 6.
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.
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.
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.
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.
内淋巴囊减压术治疗梅尼埃病的效果难以预测。这可能是因为该囊难以识别，且在不造成手术创伤的情况下准确减压很困难。
为验证这一观点，在5个尸体半头颅上模拟经乳突减压，并在另外14个标本上观察内淋巴囊的解剖结构。
在所有5次模拟减压中均找到内淋巴囊并经组织学证实。一个新描述的特征，即硬脑膜的梯形增厚，是一个有用的指引。观察显示，该囊近端恒定，但远端多变。在解剖过程中，后半规管、后颅窝硬脑膜和乙状窦有风险。
通过检查覆盖其上的硬脑膜片可识别内淋巴囊，从而减少探查性解剖。最好尽可能在近端对该囊进行减压，同时保护后半规管。
