难治性梅尼埃病手术控制眩晕的远期疗效观察

目的：观察难治性梅尼埃病手术控制眩晕的远期疗效。方法：施行内淋巴囊手术或经迷路进路前庭神经切断术治疗难治性梅尼埃病５４例,其中长期接受随访、资料完整者１２例。结果：随访８￣１３年,６例前庭神经切断术患者示再发作眩晕;６例内淋巴囊手术者,３例眩晕症状完全控制,３例基本控制。结论：肉淋巴囊手术及经迷路进行前庭神经切断术为控制难治性梅尼埃病患者眩晕的有效手段,对于有适应证的患者经迷路进路前庭神经切断术控     

梅尼埃病的手术疗效分析

目的比较前庭神经切断及内淋巴囊手术治疗梅尼埃病效果。方法将所有梅尼埃病患者根据听力及生活质量情况进行分期;根据分期情况予以非手术治疗以及内淋巴囊减压或引流术、前庭神经切断术。分析手术治疗梅尼埃病患者病史特点、手术情况;对于手术满24个月以上的梅尼埃病患者进行术前术后的眩晕、听力及生活质量等疗效评价。结果手术治疗梅尼埃病共77例患者79次手术(1例双侧梅尼埃病患者接受左右各1次内淋巴囊减压术;另1例双侧梅尼埃病患者接受了左侧前庭神经切断术及1次右侧内淋巴囊减压术),其中内淋巴囊手术34次,前庭神经切断术45次。术后24个月的眩晕控制率为:内淋巴囊手术73%,前庭神经切断术100%。结论内淋巴囊减压或引流术可以减轻患者眩晕、改善患者的生活质量;前庭神法。     

内淋巴囊-静脉减压术治疗难治性梅尼埃病

梅尼埃病的治疗仍有争论,大多药物治疗有效,仅少数药物无效者方行手术治疗。手术方法很多,目前多采用乙状窦后径路前庭神经切断术、化学性迷路破坏术、内淋巴囊减压和分流术。前庭神经切断术可保存听力,眩晕消失率高达８５％～９９％,但可因后颅窝开颅术引起颅内感染...     

广泛内淋巴囊减压术治疗梅尼埃病的应用

以眩晕的减轻或消除为指标,内淋巴囊手术的成功率介于60%至85%,且10%至56%的病人听力得到改善。1969年 Shambaugh 首次提出用广泛的内淋巴囊减压术来控制梅尼埃病。Graham 和 Kemink 随访了48位行广泛内淋巴囊减压术后的典型梅尼埃病患者,发现71%眩晕完全控制,10%明显改善,18%没有变化,没有术后症状恶化。尽管行前庭神经切断术对梅尼埃病眩晕症状的控制率更高,作者仍选择行内淋巴囊减压术,早期的手术干预能够减轻或缓解眩晕并保存听力。局麻下耳后切口暴露乳突骨皮质,行广泛的乳突根治术。显露中颅凹骨     

梅尼埃病手术方法的选择

为总结选择不同的手术方法治疗梅尼埃病的经验，分析１１９例（１１９耳）采用手术方法治疗的梅尼埃病患者。诊断和疗效评定按１９９６年上海全国会议制定的梅尼埃病诊断依据和疗效分级，在病的分期和劳动能力方面，参照ＡＡＯ－ＨＮＳ１９９５年的梅尼埃病的诊断和疗效评价标准分期：第二期４８例均行内淋巴囊分流术；第三期４４例，行Ｓｃａｒｐａ神经节切除术３２例，迷路入路前庭耳蜗神经切断术１２例；第四期２７例，行Ｓｃａｒｐａ神经节切除术４例，内淋巴囊分流术７例，前庭耳蜗神经切断术１６例。结果：内淋巴囊分流术对可逆性病变眩晕好转率为７９．２％，听力维持在正常水平者达３５．４％；Ｓｃａｒｐａ神经节切除术应用于尚存实用听力和可助听力的患者；迷路入路前庭耳蜗神经切断术对晚期梅尼埃病的耳鸣有较佳疗效。认为：根据梅尼埃病患者临床表现判断病变的可逆性和程度，实施不同的手术方法是十分重要的。     

乙状窦后径路前庭神经切断术对梅尼埃病患者听力的影响

目的 探讨乙状窦后径路选择性前庭神经切断术对梅尼埃病患者听力的影响.方法 回顾性研究2006年7月～2008年7月间,6例乙状窦后径路选择性前庭神经切断术治疗的梅尼埃病患者手术前后眩晕发作频率、纯音听阈及前庭功能的改变.结果 6例患者手术前后纯音听阈差异无统计学意义(P＞0.05);5例患者术后眩晕完全控制,1例基本控制;2例患者前庭功能完全代偿,4例部分代偿.结论 乙状窦后径路选择性前庭神经切断术能有效地控制眩晕,保留或改善患者既有听力,是治疗梅尼埃病的有效方法.     

枕下进路前庭神经切断术:结果和并发症

枕下进路前庭神经切断术是控制眩晕的有效方法，下面报告40例手术结果及并发症。4（例中梅尼埃病23例，耳蜗前庭神经压迫综合征9例、中耳炎并发的迷路炎2例，外伤及钦肯切除术后各显例、原因不明者4例。均为单侧前庭功能紊乱，4例曾行内淋巴囊手术，1村曾行迷路后前庭神经切断术。手术采用仰卧位头偏向健侧、头颈躯干抬高45“体位全麻下手术。切除前庭神经时连续监测ABR、ECOG，以免损伤耳蜗神经。术中行内听道开放者了例，未开放者33例。切斯前庭神经者37例，切断全部前庭耳蜗神经者3例。随访12个月，40例中36例（gD畅）眩晕完全消失，…     

迷路切除术与前庭神经切断术对控制眩晕的比较

对1979～1994年间经保守治疗无效的126例眩晕病人进行手术治疗作回顾性分析。126例中采用迷路．切除术sl例，前庭神经切断术45例。病因为梅尼埃病89例，迷路炎15例，迟延性内淋巴积水8例，前庭神经炎7例，迷路切除术后失败5例，其余2例因需经迷路行岩尖部囊肿造疾术而牺牲的正常迷路。比较两种手术方法对解除眩晕的疗效：迷路切除术为98．8％，前庭神经切断术为978％，但两种术式在其它方面存在显著差异。①经顿中窝前庭神经切断术常用于术前听力较好的病例，本组选择性前庭神经切断术中82％术后保存了听力，其中5例术后听力提高。一般认为…     

单纯内淋巴囊减压术治疗梅尼埃病的远期疗效

报告以单纯内淋巴囊减压术治疗梅尼埃病５８例中，经随访５－６．５年的３０例眩晕完全消失者２１例。表明单纯内淋巴囊闰坟术与内淋巴囊切开术或分流术的疗效近似而且引起严重并发症的机会较少。并对本手术的作用机理，操作要领及并发症的预防等进行讨论。     

非梅尼埃病眩晕的手术治疗

保守治疗失败的梅尼埃病患者手术治疗已普遍接受。非梅尼埃病致残性眩晕亦可手术治疗。对14例非梅尼埃病致残性眩晕的患者行迷路切除术或前庭神经切断术。其中慢性前庭神经炎4例,均行前庭神经切断术,1例治愈,3例好转。颞骨骨折2例行迷路切除术,痊愈。迟发性眩晕8例,2例行迷路切除术,6例行前庭神经切断术,均获痊愈。既往对非梅尼埃病眩晕是否采用手术治疗意见并不一致,较为普遍的看法是非梅尼埃病眩晕手术治疗效果较典型梅尼埃病差,该文采     

Tinnitus Outcome in Surgery for Vertigo

The effect of surgery for vertigo on tinnitus was evaluated in 90 patients who underwent surgery for disabling vertigo for Menieres disease. The three procedures studies included a destructive labyrinthectomy, endolymphatic sac decompression and shunt, and vestibular neurectomy. Patients who underwent a vestibular neurectomy had a significantly better tinnitus outcome than those who underwent shunt surgery (50% vs 22.7%). The labyrinthectomy and the neurectomy groups showed an equal positive response of 50%. The severity of the preoperative hearing loss did not correlate with the tinnitus outcome in all groups. Patients who have serviceable hearing and require surgery for disabling vertigo appear to have a better chance of tinnitus control with the vestibular neurectomy rather than an endolymphatic sac decompression and shunt.     

Endolymphatic sac surgery: methods of study and results

Surgery of the endolymphatic sac (ELS) in classical Meniere's disease has fallen under attack and has been abandoned by some surgeons. We studied our results for vertigo and hearing in 83 patients undergoing surgery of the ELS for intractable classical Meniere's disease. Half of the patients were completely free of definitive attacks at 2 years; another quarter experienced substantial control. Three fourths noted an improvement in their level of disability. Results for vertigo were sustained at longer follow-up intervals. Nineteen percent had revision surgery (usually retrolabyrinthine vestibular neurectomy) for intractable vertigo within 2 years of the sac operation. The 1985 reporting method of the American Academy of Otolaryngology--Head and Neck Surgery was found superior to previous methods because it specified a meaningful follow-up interval, used a graded scale accounting for partial success in treatment, and separated results for vertigo and hearing. Nevertheless, optimal use of the method in the future will require prospective reporting and a concerted effort to avoid confusion between definitive attacks of true vertigo and adjunctive vestibular symptoms. Even though the mechanism of the beneficial effect of sac surgery is unknown, we have found it useful in the control of disabling vertigo.     

梅尼埃病两种内淋巴囊手术方式的远期疗效观察

目的：评估与比较内淋巴囊乳突腔分流术（EMS）和内淋巴囊减压术（ESD）治疗梅尼埃病（MD）的远期疗效。方法：1994—06—2007—07采用内淋巴囊手术治疗原诊断为MD的患者59例,其中EMS34例,ESD25例,选择诊断符合MD诊断依据和疗效评估标准,术后2年以上、随访资料完整的23例24耳（分流术12例13耳,减压术11例11耳）进行回顾性总结。结果：EMS组12例13耳,随访3～14年,眩晕A级完全控制者9耳,B级基本控制4耳;ESD组11例11耳,随访2-14年,术后眩晕A级8耳,B级2耳,C级1耳。EMS组听力B级1耳（7．7％）,C级6耳,D级6耳;ESD组听力B级2耳（18．2％）,C级4耳,D级5耳。2组眩晕控制和听力改善差异无统计学意义。结论：EMS和ESD都是治疗MD的有效方法,对眩晕症状的控制效果满意,临床分期中晚期患者仍有疗效。     

Surgical treatment of vertigo with retrolabyrinthine vestibular neurectomy

Results for control of vertigo and preservation of hearing in patients who have had a retrolabyrinthine vestibular neurectomy (RVN) by our group were analyzed retrospectively. This procedure consists of selective section of the vestibular nerve in the posterior cranial fossa. Vertigo was completely controlled in all but two of 31 patients, one of whom required revision surgery to control attacks. Analysis of these two cases suggests that the cause of persistent vertigo is incomplete neurectomy. With our current surgical technique in patients with Meniere's disease, hearing results were not statistically different from our results with surgery of the endolymphatic sac. Control of vertigo was much more successful with the RVN than endolymphatic sac surgery.     

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.     

Endolymphatic sac drainage and steroid-instillation surgery (EDSS) for intractable Meniere's disease

Endolymphatic sac surgery is one of the most widely accepted techniques used to treat intractable Meniere's disease. To improve this surgery, we developed the following techniques: A simple mastoidectomy was used to expose the endolymphatic sac between the sigmoid sinus and inferior margin of the posterior semicircular canal. The sac was opened and filled with a mass of prednisolone. A bundle of absorbable gelatin films was then inserted into the sac lumen to expand it, followed by gelatin sponges dipped in a high concentration of dexamethasone. Long-term results (17-32 months) in 20 patients with intractable Meniere's disease treated with endolymphatic sac drainage and steroid-insertion surgery (EDSS) showed that definitive spells were completely controlled in 15 of 20 cases (75%); all reports of vertigo decreased; hearing improved in 12 of 20 cases (60%); and annoyance due to tinnitus decreased in 15 of 20 cases (75%). Steroids directly instilled into the endolymphatic cavity may thus be more effective with the diseased inner ear organs than those applied via any other route. Draining of endolymphatic fluid at the sac into the mastoid cavity also contributed to these satisfactory EDSS results.     

Surgical treatment of Menière's disease since Thomsen

The effects of Thomsen's 1981 report of a controlled double-blind study on the surgical treatment of Meniere's disease were studied by reviewing the current literature and Thomsen's subsequent reports. The current surgical literature was found to contain reasonable support for the continued use of endolymphatic shunt procedures despite the criticism of such procedures by Thomsen. Surgical therapy for Meniere's disease continues to be divided into auditory sparing or conservative procedures and auditory ablative or destructive procedures. Conservation procedures are important because approximately 30% of patients with Meniere's disease progress to bilateral involvement. Endolymphatic sac procedures continue to be classified as conservative. Important findings in the current literature are reports of long-term follow-up of patients after sac surgery. These question the long-term control of hearing loss but support the use of the procedure due to its low morbidity and consistent control of vertigo. Other authors have described the different types of endolymphatic procedures and confirm their equal effectiveness. The results of middle fossa and retrolabyrinthine vestibular neurectomy were also reviewed, and its continued control of vertigo were affirmed. The increased number of severity of complications (compared with endolymphatic shunt procedures) were noted. Finally, a strategy for surgical treatment of Meniere's disease, beginning with the patient with uncontrollable vertigo, is presented.     

梅尼埃病的个体化治疗及疗效评估

目的:探讨梅尼埃病的个性化临床治疗方法,评估梅尼埃病的非手术及手术疗效.方法:将所有梅尼埃病患者根据听力及生活质量情况进行分期;根据分期情况予以非手术治疗(改变生活方式、口服药物以及鼓室内注射地塞米松)、内淋巴囊减压或引流术、前庭神经切断术或迷路切除术.分析手术治疗梅尼埃病患者病史特点和手术情况;对于手术满1年以上的梅...