HSC Section 8_April 2017

ENDOLYMPHATIC SAC SURGERY FOR ME´ NIE` RE _ S DISEASE

FIG. 18. Vertigo control: Forest plot for current endolymphatic sac procedures (i.e., sac decompression and mastoid shunt with and without silastic in studies with short-term and long-term follow-up), short-term follow-up Category A/B vertigo control. Mean weighted follow-up was at 16 months. EMS indicates mastoid shunt; ESD, sac decompression.

hearing (8,49). The theory behind decompression is that removal of mastoid bone provides pressure relief and allows for expansion of the endolymphatic sac, thereby decreasing episodic vertigo attacks (8,70). Despite the safety and low morbidity of sac decompression, its effi- cacy in controlling vertiginous attacks of MD has been debated with great inconsistency. Some studies endorse 94% to 100% improvement (Category A/B) (13,17 Y 19), while others state 60% to 64% (16,21). In our analysis, 79.3% of patients undergoing endo- lymphatic sac decompression achieved complete or sub- stantial (Category A/B) vertigo control with a minimum

evidence points toward the endolymphatic sac contributing to the etiopathophysiology of MD.

Short-term Analysis

Decompression The first successful human endolymphatic sac de- compression procedure was performed in France in 1926 (9,10), before Hallpike and Cairns’ microscopic studies and description of labyrinthine hydrops (9,69). Since then, decompression has generally been viewed as a safe surgical option because it does not significantly impact

FIG. 19. Vertigo control: Forest plot for current endolymphatic sac procedures (i.e., sac decompression and mastoid shunt with and without silastic ), long-term follow-up Category A/B vertigo control. Mean weighted follow-up was at 79.0 months. EMS indicates mastoid shunt; ESD, sac decompression.

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