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Endolymphatic sac surgical anatomy and transmastoid decompression of the sac for the management of Ménière's disease

Published online by Cambridge University Press:  06 June 2014

R R Locke ,
J Shaw-Dunn  and
B F O'Reilly
R R Locke*
Affiliation:
Department of Anatomy, University of Glasgow, Glasgow, Scotland, UK
J Shaw-Dunn
Affiliation:
Department of Anatomy, University of Glasgow, Glasgow, Scotland, UK
B F O'Reilly
Affiliation:
Institute of Neurological Sciences, Southern General Hospital, Glasgow, Scotland, UK
*
Address for correspondence: Dr R Locke, Department of Anatomy, University of Glasgow, Glasgow G12 8QQ, Scotland, UK E-mail: [email protected]
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Abstract

Background:

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.

Methods:

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.

Results:

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.

Conclusion:

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.

Keywords

Endolymphatic SacMeniere DiseaseAnatomy
Type
Main Articles
Information
The Journal of Laryngology & Otology , Volume 128 , Issue 6 , June 2014 , pp. 488 - 493
Copyright
Copyright © JLO (1984) Limited 2014 

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Footnotes

Presented in part (and awarded the Conrad Lewin prize) at the winter meeting of the British Association of Clinical Anatomists, 15 December 2003, King's College London, UK.

References

1Morrison, A. Ménière's disease. J R Soc Med 1981;74:183–9CrossRefGoogle ScholarPubMed
2Cairns, H, Hallpike, CS. Observations on the pathology of Ménière's syndrome. Proc R Soc Med 1938;31:1317–21Google Scholar
3Schindler, R. The ultrastructure of the endolymphatic sac in man. Laryngoscope 1980;90:1–39Google Scholar
4Portmann, G. The saccus endolymphaticus and an operation for draining the same for the relief of vertigo. J Laryngol Otol 1927;42:809–17Google Scholar
5Thomsen, J, Bretlau, P, Tos, M, Johnsen, N. Placebo effect in surgery for Ménière's disease. Arch Otolaryngol Head Neck Surg 1981;107:271–7Google Scholar
6Södermann, AC, Ahlner, K, Bagger-Sjöbäck, D, Bergenius, J. Surgical treatment of vertigo – the Karolinska Hospital policy. Am J Otol 1996;17:93–8Google Scholar
7Durland, WF, Pyle, GM, Connor, NP. Endolymphatic sac decompression as a treatment for Ménière's disease. Laryngoscope 2005;115:1454–7CrossRefGoogle ScholarPubMed
8Convert, C, Franco-Vidal, V, Jean-Pierre, B, Darrouzet, V. Outcome-based assessment of endolymphatic sac decompression for Ménière's disease using the Ménière's disease outcome questionnaire: a review of 90 patients. Otol Neurotol 2006;27:687–96Google Scholar
9Wetmore, SJ. Endolymphatic sac surgery for Ménière's disease. Long-term results after primary and revision surgery. Arch Otolaryngol Head Neck Surg 2008;134:1144–8Google Scholar
10Pullens, B, Giard, JL, Verschuur, HP, van Benthem, PP. Surgery for Ménière's disease. Cochrane Database Syst Rev 2010;(2):CD005395CrossRefGoogle ScholarPubMed
11Locke, R. Anatomy of the Transmastoid Endolymphatic Sac Decompression in the Management of Ménière's Disease (PhD thesis). Glasgow: University of Glasgow, 2008Google Scholar
12Schuknecht, HF, Gulya, AJ. Endolymphatic hydrops – an overview and classification. Ann Otol Rhinol Laryngol 1983;92:1–20CrossRefGoogle Scholar
13Sanna, M, Khrais, T, Falcioni, M, Russo, A, Taibah, A. The Temporal Bone. A Manual for Dissection and Surgical Approaches. Stuttgart/New York: Thieme, 2005;42–3Google Scholar
14Nadol, JB Jr, McKenna, MJ. Surgery of the Ear and Temporal Bone, 530 Walnut Street, Philadelphia: Lippincott Williams & Wilkins, 2004;375–7Google Scholar
15Shea, DA, Chole, RA, Paparella, MM. The endolymphatic sac: anatomical considerations. Laryngoscope 1979;89:88–94CrossRefGoogle ScholarPubMed
16Bagger-Sjöbäck, D. Surgical anatomy of the endolymphatic sac. Am J Otol 1993;14:576–9Google Scholar
17Friberg, U, Birgitta, J, Rask-Andersen, H, Bagger-Sjöbäck, D. Variations in surgical anatomy of the endolymphatic sac. Arch Otolaryngol Head Neck Surg 1988;114:389–94Google Scholar
18Schuknecht, HF, Gulya, AJ. Anatomy of the Temporal Bone with Surgical Implications. Philadelphia: Lea & Febiger, 1986Google Scholar
19Bloch, SL, Friis, M. Objective measurement of the human endolymphatic sac dimensions in Ménière's disease. Otol Neurotol 2011;32:1364–9Google Scholar