The authors thank Isobel Bowring for proofreading the article, and Nele Ruysschaert for the help with information on the anesthesia.

This protocol is used for a randomized controlled trial that is currently being carried out in the Netherlands. The trial compares endolymphatic duct blockage (EDB) to endolymphatic sac decompression (ESD)9. The protocol was approved by the medical ethics committee METC Leiden-Den Haag-Delft (number P20.118) and the board of the hospital, as well as the hospital&#39;s research ethics committee (Haga Hospital Research Board, T20-108). All patients who participated in the trial where this protocol i...

<ol>
	<li>Lopez-Escamez, J. A., et al. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Diagnostic+criteria+for+Meni&#232;re's+disease.">Diagnostic criteria for Meni&#232;re's disease.</a> Journal of Vestibular Research: Equilibrium &amp; Orientation. 25 (1), 1-7 (2015).</li><li>Perez-Garrigues, H., et al. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Time+course+of+episodes+of+definitive+vertigo+in+Meniere's+disease.">Time course of episodes of definitive vertigo in Meniere's disease.</a> Archives of Otolaryngology-Head &amp; Neck Surgery. 134 (11), 1149-1154 (2008).</li><li>Alarc&#243;n, A. V., Hidalgo, L. O. V., Ar&#233;valo, R. J., Diaz, M. P. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Labyrinthectomy+and+vestibular+neurectomy+for+intractable+vertiginous+symptoms.">Labyrinthectomy and vestibular neurectomy for intractable vertiginous symptoms.</a> International Archives of Otorhinolaryngology. 21 (2), 184-190 (2017).</li><li>Pullens, B., Verschuur, H. P., van Benthem, P. P. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Surgery+for+M&#233;ni&#232;re's+disease.">Surgery for M&#233;ni&#232;re's disease.</a> Cochrane Database of Systematic Reviews. 2013 (2), (2013).</li><li>Saliba, I., Gabra, N., Alzahrani, M., Berbiche, D. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Endolymphatic+duct+blockage:+a+randomized+controlled+trial+of+a+novel+surgical+technique+for+M&#233;ni&#232;re's+disease+treatment.">Endolymphatic duct blockage: a randomized controlled trial of a novel surgical technique for M&#233;ni&#232;re's disease treatment.</a> Otolaryngology-Head and Neck Surgery. 152 (1), 122-129 (2015).</li><li>M&#248;ller, M. N., Kirkeby, S., Vikes&#229;, J., Nielsen, F. C., Cay&#233;-Thomasen, P. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=The+human+endolymphatic+sac+expresses+natriuretic+peptides.">The human endolymphatic sac expresses natriuretic peptides.</a> Laryngoscope. 127 (6), E201-E208 (2017).</li><li>Takumida, M., Bagger-Sj&#246;b&#228;ck, D., Wers&#228;ll, J., Rask-Andersen, H., Harada, Y. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Three-dimensional+ultrastructure+of+the+endolymphatic+sac.">Three-dimensional ultrastructure of the endolymphatic sac.</a> Archives of Oto-Rhino-Laryngology. 244 (2), 117-122 (1987).</li><li>Friis, M., Thomsen, A. R., Poulsen, S. S., Qvortrup, K. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Experimental+hyperactivity+of+the+endolymphatic+sac.">Experimental hyperactivity of the endolymphatic sac.</a> Audiology &amp; Neuro-Otology. 18 (2), 125-133 (2013).</li><li>Schenck, A. A., et al. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Effectiveness+of+endolymphatic+duct+blockage+versus+endolymphatic+sac+decompression+in+patients+with+intractable+M&#233;ni&#232;re's+disease:+study+protocol+for+a+double-blinded,+randomised+controlled+trial.">Effectiveness of endolymphatic duct blockage versus endolymphatic sac decompression in patients with intractable M&#233;ni&#232;re's disease: study protocol for a double-blinded, randomised controlled trial.</a> BMJ Open. 11 (8), e054514 (2021).</li><li>Lempert, T., et al. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Vestibular+migraine:+Diagnostic+criteria.">Vestibular migraine: Diagnostic criteria.</a> Journal of Vestibular Research: Equilibrium &amp; Orientation. 32 (1), 1-6 (2022).</li><li>Schenck, A. A., Bommelj&#233;, C. C., Kruyt, J. M. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Outcomes+of+endolymphatic+duct+blockage+for+M&#233;ni&#232;re's+disease:+an+observational+cohort+study.">Outcomes of endolymphatic duct blockage for M&#233;ni&#232;re's disease: an observational cohort study.</a> American Journal of Otolaryngology and Head. 4 (5), 1140 (2021).</li><li>Kato, B. M., LaRouere, M. J., Bojrab, D. I., Michaelides, E. M. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Evaluating+quality+of+life+after+endolymphatic+sac+surgery:+The+M&#233;ni&#232;re's+Disease+Outcomes+Questionnaire.">Evaluating quality of life after endolymphatic sac surgery: The M&#233;ni&#232;re's Disease Outcomes Questionnaire.</a> Otology &amp; Neurotology. 25 (3), 339-344 (2004).</li><li>Kimura, R. S. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Experimental+blockage+of+the+endolymphatic+duct+and+sac+and+its+effect+on+the+inner+ear+of+the+guinea+pig.+A+study+on+endolymphatic+hydrops.">Experimental blockage of the endolymphatic duct and sac and its effect on the inner ear of the guinea pig. A study on endolymphatic hydrops.</a> The Annals of Otology, Rhinology, and Laryngology. 76 (3), 664-687 (1967).</li><li>Lundquist, P. G. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Aspects+on+endolymphatic+sac+morphology+and+function.">Aspects on endolymphatic sac morphology and function.</a> Archives of Oto-Rhino-Laryngology. 212 (4), 231-240 (1976).</li><li>Lundquist, P. G., Kimura, R., Wersaell, J. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Experiments+in+endolymph+circulation.">Experiments in endolymph circulation.</a> Acta Oto-Laryngologica. Supplementum. 188, 198 (1964).</li><li>Wackym, P. A., et al. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Human+endolymphatic+sac:+possible+mechanisms+of+pressure+regulation.">Human endolymphatic sac: possible mechanisms of pressure regulation.</a> The Journal of Laryngology and Otology. 101 (8), 768-779 (1987).</li><li>Linthicum, F. H., Santos, F. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Endolymphatic+sac+amputation+without+hydrops.">Endolymphatic sac amputation without hydrops.</a> Otology &amp; Neurotology. 32 (2), e12-e13 (2011).</li><li>Niu, Y., Chen, W., Lin, M., Sha, Y. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Progression+of+endolymphatic+hydrops+and+vertigo+during+treatment+in+Meniere's+disease.">Progression of endolymphatic hydrops and vertigo during treatment in Meniere's disease.</a> Acta Oto-Laryngologica. 142 (9-12), 653-657 (2022).</li><li>Merchant, S. N., Adams, J. C., Nadol, J. B. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Pathophysiology+of+Meniere's+syndrome:+are+symptoms+caused+by+endolymphatic+hydrops.">Pathophysiology of Meniere's syndrome: are symptoms caused by endolymphatic hydrops.</a> Otology &amp; Neurotology. 26 (1), 74-81 (2005).</li><li>Basura, G. J., et al. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Clinical+practice+guideline:+M&#233;ni&#232;re's+disease.">Clinical practice guideline: M&#233;ni&#232;re's disease.</a> Otolaryngology-Head and Neck Surgery. 162, S1-S55 (2020).</li><li>Hussain, K., Murdin, L., Schilder, A. G. M. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Restriction+of+salt,+caffeine+and+alcohol+intake+for+the+treatment+of+M&#233;ni&#232;re's+disease+or+syndrome.">Restriction of salt, caffeine and alcohol intake for the treatment of M&#233;ni&#232;re's disease or syndrome.</a> Cochrane Database of Systematic Reviews. 12, (2018).</li><li>Burgess, A., Kundu, S. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Diuretics+for+M&#233;ni&#232;re's+disease+or+syndrome.">Diuretics for M&#233;ni&#232;re's disease or syndrome.</a> Cochrane Database of Systematic Reviews. 3, (2006).</li><li>van Esch, B., et al. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Betahistine+for+Meni&#232;re's+disease+or+syndrome.">Betahistine for Meni&#232;re's disease or syndrome.</a> Cochrane Database of Systematic Reviews. 1, (2001).</li><li>Phillips, J. 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EDB is a potential new treatment modality, aiming to reduce vertigo attacks while sparing inner ear function in patients with intractable MD. In the current literature, the results seem promising, but little data is available.
Rationale of the technique 
Targeting the ES for relieving MD symptoms has been controversial for some decades. In the past, the general belief has been that the (ES) mainly has a role in the resorption of endolymph13,</...

M&#233;ni&#232;re&#39;s disease (MD) is an incapacitating disease characterized by vertigo bouts, aural symptoms, and hearing loss1. Endolymphatic hydrops in the inner ear is present in patients with MD, but the exact aetiology of the disease remains unclear. In most patients, the symptoms resolve over time2; despite this, the majority of patients seek active treatment because of the unpredictable pattern of attacks.
Treatment for MD aims to reduce vertigo attacks. In the past century, different treatment modalities have been proposed, both surgical and non-surgical. Destructive surgical interventions, such as labyrinthectomy or vestibular neurotomy, are effective in controlling vertigo but cause deafness and a loss of vestibular function on the operated ear3,4. Surgeries on the endolymphatic sac (ES) have been studied, such as decompression and shunting of the sac, but neither of the proposed interventions have been proven to be more effective than placebo surgery4.
In 2015, Saliba et al. published the results of a randomized controlled trial comparing a new technique, endolymphatic duct blockage (EDB), to endolymphatic sac decompression (ESD)5. The trial yielded promising results, with 96.5% of the patients in the EDB group being free of vertigo attacks after 2 years. The rationale behind this technique is that the ES is at least partially responsible for the disturbed homeostasis of endolymph and produces an overload of endolymph due to increased production. By blocking the endolymphatic duct (ED), the surplus of endolymph that is generated in the sac is hindered from flowing to the rest of the inner ear. This hypothesis is supported by histological studies6,7,8.
Whether EDB is the appropriate treatment for an individual patient depends on various factors. The patient&#39;s preference and the surgeon&#39;s preference play a role, but local health care regulations may also influence treatment choice. In our center, EDB is only considered in patients who suffer vertigo attacks despite treatment with intratympanic (IT) injections with corticosteroids, and if vestibular migraine has been ruled out. EDB is especially suitable for patients with good hearing function who reject ablative treatment. This article describes the surgical steps of this new technique and discusses the literature that is currently available.

<table border="1" fo:keep-together.within-page="1" fo:keep-with-next.within-page="always">
	<tbody>
		<tr>
			<td>Adson Forceps, Delicate, Smooth, 1 x 2 teeth, 12 0mm</td>
			<td>Aesculap BV</td>
			<td>BD511R</td>
			<td></td>
		</tr>
		<tr>
			<td>Adson-Brown Tissue Forceps, 7 x 8 teeth, 120 mm</td>
			<td>Aesculap BV</td>
			<td>BD700R</td>
			<td></td>
		</tr>
		<tr>
			<td>Baby Adson Retractor, hinged, semi-S tip, 3 x 4 prongs blade end, 140 mm</td>
			<td>Aesculap BV</td>
			<td>BV085R</td>
			<td></td>
		</tr>
		<tr>
			<td>Baby Senn-Miller RetractorFlat Handle, SHARP tip, 3 PRONGS blade end, blade size 8 x 7/22 x 7, 165 mm</td>
			<td>Aesculap BV</td>
			<td>BT006R</td>
			<td></td>
		</tr>
		<tr>
			<td>Bien Air Nano Micromotor OsseoDUO + NANOmicromotor</td>
			<td>Bien air</td>
			<td>1700524-001</td>
			<td>Electronic motor used for mastoidectomy</td>
		</tr>
		<tr>
			<td>Bien air tubing set for peristaltic pump</td>
			<td>Bien air</td>
			<td>1100037</td>
			<td></td>
		</tr>
		<tr>
			<td>Coagulation Forceps</td>
			<td>Aesculap BV</td>
			<td>E700246</td>
			<td>Used for hemostasis</td>
		</tr>
		<tr>
			<td>Cord, bipolar, 4.5 m</td>
			<td>Valleylab BV</td>
			<td>E360150L</td>
			<td></td>
		</tr>
		<tr>
			<td>Diamond burrs 0.8x 70 to 7.0x70</td>
			<td>Bien air</td>
			<td></td>
			<td></td>
		</tr>
		<tr>
			<td>Ear Curette, Pointed, Double Ended, cup size LARGE, 170 mm</td>
			<td>Aseculap BV</td>
			<td>OG189R</td>
			<td></td>
		</tr>
		<tr>
			<td>Ethicon hechtdraad 3/0 sh-1 vicryl 70 cm</td>
			<td>Ethicon</td>
			<td>3006273</td>
			<td>Suture for deeper tissue layers</td>
		</tr>
		<tr>
			<td>Fibrin Sealant</td>
			<td>Baxter BV</td>
			<td>BE-90-01-040</td>
			<td>Tissue glue used in case of liquor leakage</td>
		</tr>
		<tr>
			<td>Gillies Skin Hook, Tip 0.5/6mm, jaw STR, SERR</td>
			<td>Aesculap BV</td>
			<td>OL611R</td>
			<td></td>
		</tr>
		<tr>
			<td>Gillies Tissue Forceps, Delicate, X-SERR tip, 1 x 2 teeth, 155 mm</td>
			<td>Aesculap BV</td>
			<td>BD660R</td>
			<td></td>
		</tr>
		<tr>
			<td>Halsted Mosquito Forceps, Delicate, CVD jaw, 125 mm</td>
			<td>Aesculap BV</td>
			<td>BH111R</td>
			<td></td>
		</tr>
		<tr>
			<td>Handpiece for burr</td>
			<td>Bien air</td>
			<td>1600830-001</td>
			<td></td>
		</tr>
		<tr>
			<td>Hartmann Ear Forceps , Tip 4 mm, jaw STR</td>
			<td>Aesculap BV</td>
			<td>OG329R</td>
			<td></td>
		</tr>
		<tr>
			<td>Hartmann-Wullstein Ear Forceps</td>
			<td>Aesculap BV</td>
			<td>OF410R</td>
			<td></td>
		</tr>
		<tr>
			<td>Hejek Mallet, &#216;27 220 mm</td>
			<td>Aesculap BV</td>
			<td>FL044R</td>
			<td></td>
		</tr>
		<tr>
			<td>Horizon Metal Ligation System - Clips size MICRO, SMALL, MEDIUM</td>
			<td>Teleflex Medical</td>
			<td>1201, 2200, 5200</td>
			<td>Titanium clip used for blockage of endolymphatic duct</td>
		</tr>
		<tr>
			<td>House Ear Curette</td>
			<td>Aesculap BV</td>
			<td>OG182R</td>
			<td>Double Ended, cup size (mm) 1.5/1.8, tip ANG</td>
		</tr>
		<tr>
			<td>Lucae Bayonet Forceps</td>
			<td>Aesculap BV</td>
			<td>BD878R</td>
			<td>SERR tip, 140mm</td>
		</tr>
		<tr>
			<td>Lucae Bayonet Forceps</td>
			<td>Aesculap</td>
			<td>BD878R</td>
			<td>SERR tip, 140mm</td>
		</tr>
		<tr>
			<td>Lucae Ear Hook Button</td>
			<td>Aesculap BV</td>
			<td>OF278R</td>
			<td>Hook end SMALL, tip SHARP, 130mm</td>
		</tr>
		<tr>
			<td>Mayo Dissecting Scissors</td>
			<td>Aesculap BV</td>
			<td>BC587R</td>
			<td>Round Blade, B/B tip, CVD blade, 165mm</td>
		</tr>
		<tr>
			<td>Mayo Dissecting Scissors, Round Blade, B/B tip, CVD blade, 165 mm</td>
			<td>Aesculap BV</td>
			<td>BC587R</td>
			<td></td>
		</tr>
		<tr>
			<td>McIndoe Thumb Forceps, Delicate</td>
			<td>Aesculap BV</td>
			<td>BD236R</td>
			<td>SERR tip, 150 mm</td>
		</tr>
		<tr>
			<td>Micro Adson Forceps, Delicate, SERR with platform tip Tip, 12 cm</td>
			<td>Aesculap BV</td>
			<td>BD220R/425.112</td>
			<td></td>
		</tr>
		<tr>
			<td>Monocryl 4-0 FS-2. 70 cm</td>
			<td>Ethicon</td>
			<td>Y422H</td>
			<td>Suture for skin</td>
		</tr>
		<tr>
			<td>NIM response 3.0</td>
			<td>Medtronic</td>
			<td>NIM4CM01</td>
			<td>Nerve monitoring system</td>
		</tr>
		<tr>
			<td>OSSEODUO control unit</td>
			<td>Bien air</td>
			<td>1600513-001</td>
			<td></td>
		</tr>
		<tr>
			<td>Paired Subdermal electrodes with subdermal ground electrode and subdermal stim return, 2 channel</td>
			<td>Medtronic Xomed</td>
			<td>8227410</td>
			<td></td>
		</tr>
		<tr>
			<td>Scalpel Handle #3&#160; F/ Blades</td>
			<td>Aesculap BV</td>
			<td>BB070R</td>
			<td></td>
		</tr>
		<tr>
			<td>Steel burrs 0.8x 70 to 7.0x 70</td>
			<td>Bien air</td>
			<td></td>
			<td></td>
		</tr>
		<tr>
			<td>Volkmann Curette, tip size 3.6 mm, 170 mm</td>
			<td>Aesculap BV</td>
			<td>FK631R</td>
			<td></td>
		</tr>
		<tr>
			<td>Watertight, 2-button multifunction pedal</td>
			<td>Bien air</td>
			<td>1600517-001</td>
			<td></td>
		</tr>
		<tr>
			<td>Williger Bone Elevator, blade 6, 160 mm</td>
			<td>Aesculap BV</td>
			<td>FK300R</td>
			<td></td>
		</tr>
		<tr>
			<td>Wire bending forceps, curved downards, 80 mm, jaw length 3.50 mm, with tubular shaft</td>
			<td>McGee</td>
			<td>OG359R</td>
			<td>Used to close clip</td>
		</tr>
		<tr>
			<td>Wullstein Retractor, sharp tip, 3 x 3 prongs blade end, 130 mm</td>
			<td>Aesculap BV</td>
			<td>BV076R</td>
			<td></td>
		</tr>
	</tbody>
</table>

endolymphatic duct blockage as a surgical treatment option for m&#233;ni&#232;re's disease

Endolymphatic duct blockage is a relatively new treatment option for M&#233;ni&#232;re's disease, aiming to reduce vertigo attacks while sparing hearing and equilibrium. After a regular mastoidectomy, the posterior semicircular canal is identified, and Donaldson's line is determined. This is a line through the horizontal semicircular canal, crossing the posterior semicircular canal. The endolymphatic sac is usually found at this site under the posterior semicircular canal. The bone of the endolymphatic sac and the dura are thinned until the sac is skeletonized, after which the endolymphatic duct is identified. The duct is then blocked with a titanium clip. Using a computerized tomography (CT) scan, the position is confirmed. Follow-up visits take place 1 week, 6 weeks and 1 year after surgery. To this day, only one prospective trial assessing this method has been conducted, comparing this new method to endolymphatic sac decompression. Results of the duct blockage are promising, with 96.5% of the patients free of vertigo after 2 years. However, further research is required.

Surgical factors 
This procedure was performed by one of the authors (HB) in both the Haga Hospital and the Antwerp University Hospital. Data from the Antwerp University Hospital could not be retrieved, but approximately 100 patients underwent EDB at that location. In the Haga Hospital, EBD is only allowed in the context of the aforementioned trial. In this trial, surgery was performed on 38 patients. Due to the blinded character of the trial, it is unknown how many and which of these patients under...

Watch this Scientific Journal Video about Endolymphatic Duct Blockage as a Surgical Treatment Option for MÃƒÂ©niÃƒÂ¨re's Disease at JoVE.com

Endolymphatic Duct Blockage as a Surgical Treatment Option for M&#233;ni&#232;re's Disease

Endolymphatic duct blockage is a relatively new surgical method for patients suffering from M&#233;ni&#232;re's disease. Following a regular mastoidectomy, the endolymphatic duct is identified and ligated using a regular titanium hemoclip. The effectiveness of this procedure is currently being assessed in a randomized trial.

Endolymphatic duct blockage is a relatively new treatment option for M&#233;ni&#232;re's disease, aiming to reduce vertigo attacks while sparing hearing ...

1 Endolymphatic duct blockage<v>2 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.

endolymphatic-duct-blockage-as-surgical-treatment-option-for-meniere

Research

JoVE Journal

Medicine

689 visualizações.  Haga Hospital. 1 O bloqueio do ducto endolinfático2 é um novo procedimento cirúrgico que pode ser eficaz 3 para pacientes com doença de Ménière intratável. 4 A principal vantagem dessa técnica 5 é que ela preserva a função da orelha interna, 6 como equilíbrio e audição, enquanto interrompe os ataques de vertigem. 7 Comece colocando a unidade de anestesia 8 na extremidade do pé do paciente na sala de cirurgia.9 Coloque o painel de controle 10 do ...