Combined vestibular neurectomy and endolymphatic sac shunt via the retrosigmoid approach in the treatment of Ménière's disease.

The nature of surgical treatment for Ménière's disease has evolved from destructive to conservative in the interest of preserving hearing. We have performed a combined procedure that involves a vestibular neurectomy to control vertigo, which is followed by an endolymphatic sac shunt to control hydrops in 26 patients. Both procedures are performed via the retrosigmoid approach during the same surgical step. We believe this combination procedure is a worthwhile option to consider in order to achieve good control of vertigo and endolymphatic hydrops and to preserve hearing in patients with Ménière's disease.

Surgical treatment of vertigo by utriculostomy: an experimental study in sheep.

The objective of this study was to develop and test an endolabyrinthic microsurgical procedure for treatment of vertigo, the utriculostomy. This involves the application of local heat for obtaining a fistula in the membranous labyrinth, so as to establish communication between the endolymphatic and perilymphatic spaces at the utricle level. Before the procedure, an experimental model using quail eggs was built for pre-evaluation, and macroscopic and histological studies were performed in the temporal bones of three healthy sheep. Following this, the utriculostomy was performed through the oval window in 12 sheep. A microthermocautery was conceived by the first author and developed at Hospital de Clinicas de Porto Alegre. This equipment allows for control of temperature and duration of exposure to heat. Three months after the surgery, the animals were killed. A histological study of the temporal bones was performed to assess whether communication had been created between the endolymphatic and perilymphatic spaces, or whether a neomembrane had developed in the cauterized region. Histological sections of the vestibule of eight animals (three normal, five surgical) were analysed. All non-surgical cases presented a normal utricle wall. Three surgical cases (60%) presented a neomembrane. The absence of identifiable perforations in the utricle wall and the presence of neomembrane areas in 60% of the operated bones suggest that utriculostomy is a promising procedure for the treatment of Meniere's disease.