Endolymphatic Duct Blockage as a Surgical Treatment Option for Ménière's Disease

1 Endolymphatic duct blockage2 is a new surgical procedure that may be effective 3 for patients suffering intractable Meniere's disease. 4 The main advantage of this technique 5 is that it preserves inner ear function, 6 such as balance and hearing, while stopping vertigo attacks. 7 Begin by placing the anesthesia unit 8 at the foot end of the patient in the operating room.

9 Place the control panel 10 of the intraoperative neuro-monitoring system 11 as far away from the patient's head as possible. 12 After positioning the patient, with a scalpel, 13 make a seven to eight-centimeter long 14 retroauricular incision 15 just behind the auricle of the sterilized ear. 16 Spread the subcutaneous layers 17 until the temporal muscles are visible cranially.

18 Make a U-shaped incision to the petrous bone 19 to create a palva flap. 20 Using a pair of forceps and a respiratorium, 21 peel the periosteum off the cortex 22 until the external auditory canal is seen. 23 Position two spreaders in the tissue layers 24 to expose the petrous bone.

25 Form a triangle and bur through the cortex 26 to identify the mastoid cells. 27 Identify the coddle sigmoid sinus 28 and cranial dura as landmarks. 29 Identify the dura of the posterior fossa 30 and the curvature of the horizontal vestibular canal.

31 Next, locate the posterior semi-circular canal 32 and the dura mater of the posterior fossa. 33 Identify the prominence 34 of the horizontal semi-circular canal 35 and locate Donaldson's line 36 to approximate the position of the endo lymphatic sack. 37 Using diamond burs, thin the bone over the sack and the dura 38 and skeletonize the endo lymphatic sack completely.

39 Expose the dura by removing the remaining bone. 40 Use an elevator to lift the dura towards the brain, 41 exposing the median wall of the posterior canal 42 to identify the endo lymphatic sack. 43 Using the elevator, create a site 44 to insert the tip of the instrument to clip the duct.

45 After determining the right clip fit, 46 cover the patient with a sterile cover 47 and perform a CT scan without closing the clip. 48 Choose the protocol 20 SDCT head micro under the 3D head, 49 and follow the activate stand movements. 50 Choose skull base set up in the coddle cranial direction 51 and follow the necessary 3D activate stand movement steps.

52 Once the scanning is complete, 53 choose the preset Dyna-CT head petrosa. 54 Access the images to check if the clip 55 is positioned correctly. 56 Using an elevator, remove the clip.

57 Close the clip over the endo lymphatic duct. 58 Use a 70 centimeters long absorbable poly-filament suture 59 to close the palva flap and the subcutaneous layer. 60 Using another 70 centimeters long, 61 absorbable monofilament suture, 62 apply a subcutaneous continuous suture to close the skin.

63 Cover the closed skin and head with plasters and a bandage. 64 Among the 26 patients who participated in the study, 65 there were slightly more females than males, 66 and the left ear was the most affected. 67 Outcomes of the subjective complaints, 68 after endo lymphatic duct blockage, are shown here.

69 85%of the patients 70 had fewer complaints of vertigo after the procedure. 71 Take the utmost care when thinning the bone over the sack. 72 The dura under the bone is usually very thin 73 and rupture leads to spinal cerebral fluid leakage.

74 This technique may prove to be effective 75 for Meniere's disease, while sparing inner ear function.