Department of Otorhinolaryngology, Head and Neck Surgery, Medical University of Warsaw, Poland.
Department of Otorhinolaryngology, Head and Neck Surgery, Medical University of Warsaw, Poland.
Auris Nasus Larynx. 2022 Aug;49(4):584-592. doi: 10.1016/j.anl.2021.12.001. Epub 2021 Dec 20.
The aim was to evaluate endolymphatic hydrops in patients with Ménière's disease before and after vestibular neurectomy to verify if the endolymphatic space dilatation, observed in magnetic resonance imaging, regressed within several months after surgery.
Magnetic resonance imaging was performed after intravenous gadolinium injection in four patients with unilateral definite Ménière's disease before and eight months after vestibular neurectomy. Clinical symptoms, audiovestibular tests, and endolymphatic hydrops in magnetic resonance imaging were evaluated.
Endolymphatic hydrops was visualized in preoperative magnetic resonance imaging in three out of four analyzed patients. In the remaining one, an asymmetrical contrast enhancement in the affected ear was found. After the vestibular neurectomy, all four patients presented a complete resolution of vertigo episodes and improved functional level. Significant postoperative hearing deterioration was found in two patients. In the follow-up magnetic resonance imaging, no reduction of the endolymphatic hydrops was visualized. A reduction of asymmetrical contrast enhancement in one patient was found.
Magnetic resonance imaging of the inner ear is a helpful diagnostic tool for Menière's disease. Vestibular neurectomy is an effective treatment for intractable vertigo; however, there is no endolymphatic hydrops regression evidence within several months after the surgery. Therefore, further studies with a long follow-up period and repeated magnetic resonance imaging are needed to assess the vestibular neurectomy's impact on endolymphatic hydrops. Nevertheless, magnetic resonance imaging supports the clinical diagnosis of Ménière's disease and may help understand its pathophysiology.
评估梅尼埃病患者前庭神经切断术前、后内淋巴积水的情况，以验证磁共振成像（MRI）观察到的内淋巴间隙扩张是否在术后数月内消退。
对 4 例单侧明确梅尼埃病患者，在接受静脉注射钆造影剂后分别于术前和术后 8 个月行 MRI 检查。评估临床症状、听前庭功能测试和 MRI 中的内淋巴积水情况。
4 例患者中，3 例术前 MRI 可见内淋巴积水，另 1 例患侧出现不对称性对比增强。前庭神经切断术后，所有患者的眩晕发作完全缓解，功能水平改善。2 例患者出现显著的术后听力恶化。在随访 MRI 中，未见内淋巴积水减少，1 例患者的不对称性对比增强减少。
内耳 MRI 是梅尼埃病的一种有用的诊断工具。前庭神经切断术是治疗顽固性眩晕的有效方法；但术后数月内未见内淋巴积水消退的证据。因此，需要进一步进行长期随访和重复 MRI 检查的研究，以评估前庭神经切断术对内淋巴积水的影响。然而，MRI 支持梅尼埃病的临床诊断，并可能有助于了解其病理生理学。
