Gianoli G J, Larouere M J, Kartush J M, Wayman J
Department of Otolaryngology-Head and Neck Surgery, Tulane University Medical Center, New Orleans, Louisiana 70112, USA.
Otolaryngol Head Neck Surg. 1998 Jan;118(1):22-9. doi: 10.1016/S0194-5998(98)70370-5.
Surgical intervention has been offered to patients with Meniere's disease who have failed medical treatment and have disabling symptoms. Surgical options have included labyrinthectomy (mechanical and chemical), vestibular neurectomy, and endolymphatic sac surgery with or without shunting. We present a modification of endolymphatic sac decompression surgery that includes wide decompression of the sigmoid sinus, posterior cranial fossa dura, and endolymphatic sac (sac-vein decompression). Thirty-five patients underwent 37 primary procedures with 2 years of follow-up. Patients were evaluated according to the 1985 American Academy of Otolaryngology-Head and Neck Surgery criteria for assessing Meniere's disease. Vestibular symptom severity was resolved or mild in 92% and disability severity was none or mild in 95% of patients at 2 years after surgery. Vertigo control was complete or substantial in 85% and 100% of patients at 1 and 2 years after surgery. Audiologic data showed stable or improved hearing in 86% and 85% of patients at 1 and 2 years after surgery. In summary, wide decompression of the sigmoid sinus, posterior cranial fossa dura, and endolymphatic sac offers improved control of vertigo and hearing stabilization for intractable Meniere's disease compared with simple endolymphatic sac decompression or shunt surgery.
对于药物治疗无效且症状严重影响生活的梅尼埃病患者，可考虑手术干预。手术选择包括迷路切除术（机械性和化学性）、前庭神经切除术以及伴有或不伴有分流的内淋巴囊手术。我们提出了一种改良的内淋巴囊减压手术，包括对乙状窦、后颅窝硬脑膜和内淋巴囊进行广泛减压（囊 - 静脉减压）。35例患者接受了37次初次手术，并进行了2年的随访。根据1985年美国耳鼻咽喉 - 头颈外科学会评估梅尼埃病的标准对患者进行评估。术后2年时，92%的患者前庭症状严重程度得到缓解或为轻度，95%的患者残疾严重程度为无或轻度。术后1年和2年时，分别有85%和100%的患者眩晕得到完全或显著控制。听力学数据显示，术后1年和2年时，分别有86%和85%的患者听力稳定或改善。总之，与单纯的内淋巴囊减压或分流手术相比，对乙状窦、后颅窝硬脑膜和内淋巴囊进行广泛减压能更好地控制眩晕并稳定难治性梅尼埃病患者的听力。
