Jasińska-Nowacka Agnieszka, Lachowska Magdalena, Wnuk Emilia, Niemczyk Kazimierz
Department of Otorhinolaryngology Head and Neck Surgery, Medical University of Warsaw, ul. Banacha 1a, Warszawa (Warsaw), 02-097, Poland.
Department of Clinical Radiology, Medical University of Warsaw, Warsaw, Poland.
Acta Neurol Belg. 2024 Dec;124(6):1923-1934. doi: 10.1007/s13760-024-02605-x. Epub 2024 Jul 30.
The aim was to evaluate endolymphatic hydrops in patients with severe Ménière's disease (MD) before and after vestibular neurectomy to verify if vestibular denervation results in hydrops regression.
Magnetic resonance imaging was performed after intravenous gadolinium injection in twenty patients with unilateral definite MD before and after the vestibular neurectomy. Clinical symptoms and audiovestibular tests were evaluated. Follow-up intervals ranged from 18 to 35 months after the surgery.
Endolymphatic hydrops were visualized in all patients in the preoperative scans. After the vestibular neurectomy, all patients presented a complete resolution of vertigo episodes. Regression of the endolymphatic hydrops was observed in 35% and 15% of cases analyzing cochlea and vestibule, respectively. In 71.43% of patients with utricular herniation into the lateral semicircular canal, withdrawal of the hernia was visualized. Asymmetrical contrast enhancement in the cochlea regressed in 17.64% of cases. Analyzing all the parameters collectively, in 60% of patients, partial regression of at least one of the radiological signs was confirmed in the follow-up examination. No progression of the endolymphatic hydrops was visualized after the surgery in either the cochlea or the vestibule.
Vestibular neurectomy is an effective treatment, eliminating vertigo attacks and improving the quality of life in patients with MD. Magnetic resonance imaging of the inner ear allows visualization of changes in endolymphatic hydrops degree after treatment. Regression of the endolymphatic hydrops after vestibular neurectomy suggests that vestibular denervation may effectively halt the progression of the endolymphatic space dilatation and result in hydrops regression.
旨在评估重度梅尼埃病（MD）患者在前庭神经切除术前和术后的内淋巴积水情况，以验证前庭去神经支配是否会导致积水消退。
对20例单侧明确MD患者在前庭神经切除术前和术后静脉注射钆后进行磁共振成像检查。评估临床症状和听前庭测试。术后随访时间为18至35个月。
术前扫描中所有患者均可见内淋巴积水。前庭神经切除术后，所有患者眩晕发作完全缓解。分别分析耳蜗和前庭时，35%和15%的病例观察到内淋巴积水消退。在71.43%的椭圆囊疝入外侧半规管的患者中，可见疝回纳。耳蜗不对称强化在17.64%的病例中消退。综合分析所有参数，60%的患者在随访检查中至少有一项影像学征象部分消退得到证实。术后在耳蜗或前庭均未观察到内淋巴积水进展。
前庭神经切除术是一种有效的治疗方法，可消除MD患者的眩晕发作并改善生活质量。内耳磁共振成像可观察到治疗后内淋巴积水程度的变化。前庭神经切除术后内淋巴积水消退表明前庭去神经支配可能有效阻止内淋巴间隙扩张的进展并导致积水消退。
