This page was last updated on: April 7, 2012
The endolymphatic shunt operation consists of opening the mastoid bone and identifying the endolymphatic sac which is located in the posterior fossa dura. To find the sac, the sigmoid sinus is denuded of its bony cover except for a small rectangle of thin bone named Bill's Island, after Dr. William House. The sigmoid sinus is then collapsed with gentle pressure and the sac exposed behind the posterior semicircular canal. The sac is then incised and a shunt tube is inserted. The picture on the right shows a Huang-Gibson tube with a one-way valve that allows fluid to seep out but not back into the sac. This procedure decreases the endolymphatic fluid pressure.
Endolymphatic Shunt Operation
Welling DB, Nagaraja HN.
Departments of Otolaryngology and Statistics, Ohio State University, OH, USA.
OBJECTIVES: The main goal of this paper was to statistically reevaluate the efficacy of the endolymphatic shunt procedure for Meniere's disease. METHODS: Thomsen et al (Arch Otolaryngol 1981;107:271-7) reported on the placebo effect in surgery for Meniere's disease in a controlled double-blind study. Thirty patients with typical Meniere's disease in whom medical treatment failed participated in the study. A placebo-controlled blinded surgical study has not since been replicated. We performed a retrospective statistical analysis using data extracted from the published report and reanalyzed it using both the original and new statistical measures and techniques. RESULTS: The original conclusions drawn by Thomsen et al differed considerably from ours in 5 key areas, including postoperative vertigo, nausea and vomiting, tinnitus, and combined score. CONCLUSIONS: This analysis strongly supports the effectiveness of the endolymphatic shunt in the management of Meniere's disease and refutes the placebo effect previously proposed.
Pensak ML, Friedman RA.
Department of Otolaryngology Head and Neck Surgery, University of Cincinnati College of Medicine, Ohio 45267-0528, USA.
OBJECTIVE: Ongoing controversy regarding the surgical management of Meniere's disease has prompted us to review the effectiveness of the endolymphatic mastoid shunt procedure in the control of vertigo. In the current managed care environment in which outcome measures, cost effectiveness, and procedural efficacy must be demonstrated, the surgeon can no longer rely on anecdotal or empirical observations regarding the effectiveness of a treatment paradigm. STUDY DESIGN: Retrooperative case review. SETTING: A tertiary care center. PATIENTS: The records of 327 patients with presumed Meniere's-related vertigo referred to the University of Cincinnati Medical Center were reviewed. One hundred nine patients underwent endolymphatic mastoid shunt. Our study population consists of 96 of these patients that were available for 5 years follow-up. INTERVENTIONS: Endolymphatic mastoid shunt for the control of medically refractory vertigo. MAIN OUTCOME MEASURE: Control of vertigo. RESULTS: Using the Arenberg anatomic classification system, patients with a type I endolymphatic sac achieved 68% control of vertigo, those with a type II endolymphatic sac had a 92% control rate, and patients with a type III endolymphatic sac achieved 78% relief. CONCLUSIONS: Based on an assessment of outcome variables, we conclude that there remains a definite role for endolymphatic shunt surgery in the contemporary approach to patients with Meniere's disease.
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