Surgical treatment of Meniere's disease

Surgical treatment of Meniere's disease is used in severe forms of this disease and the absence of effect from non-surgical treatment. This type of treatment has only one goal - to get rid of painful attacks, while the patient's suffering forces him to sacrifice his already poor hearing in the affected ear. There are several fundamental approaches to surgical treatment of Meniere's disease:

1. operations aimed at eliminating or preventing hydrops by creating drainage holes in the endolymphatic space through which endolymph could flow into various "reservoirs" and be removed from there naturally; these methods include the following options for draining the endolymphatic space:
   1. drainage of the endolymphatic sac with the direction of endolymph either into the cells of the mastoid process or into the subarachnoid space; the effectiveness of the operation is low, since the drainage holes and shunts are short-lived, and attacks recur after some time;
   2. fenestration of the cochlea with drainage or shunting involves the formation of an opening in the area of the cape (the main turn of the cochlea) with penetration through the wall of the membranous part of the cochlea into the ductus cochlearis and the insertion of a drainage tube into it;
   3. cochlear bypass surgery through its window; polyethylene or metal tubes (0.8-1 mm in diameter, 4 mm in length) are used as a shunt, the distal end of which is sealed, and the wall is perforated with small holes for the flow of endolymph into the perilymphatic space;
2. operations aimed at normalizing hemodynamics in the inner ear and reflex blocking of pathological impulses from the affected labyrinth; such operations include resection of the tympanic plexus and tympanic plexus, operations on the sympathetic cervical ganglia and the cervical sympathetic trunk:
   1. resection of the tympanic membrane involves opening the tympanic cavity using endaural tympanotomy, exposing the tympanic membrane and resecting a portion of it 5-8 mm long;
   2. operations on the tympanic plexus - its cruciform intersection (according to J. Lempert) or its circular excision together with the mucoperiosteal flap (according to I.B. Soldatov; in this case, as noted by I.B. Soldatov et al. (1980), the mucoperiosteal area in the region of the upper edge of the cochlear window, where the most constant branches of the tympanic plexus pass, must also be removed;
3. destructive methods are distinguished by their significant radicalism and the greatest postoperative effect, but they are also the most traumatic; these methods pursue the goal of total shutdown of the causal labyrinth; indications for the use of these methods are the ineffectiveness of trepanation and shunting of the labyrinth, the neuritic form of Meniere's disease in the absence of excitability of the vestibular apparatus, with a suspicion of a retrolabyrinthine cause of the disease; with partial preservation of auditory function, they resort to isolated intersection of the vestibular portion of the prevestibule-cochlear nerve.

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Destructive methods of treatment of Meniere's disease

Destructive methods of treating Meniere's disease include labyrinthectomy with removal of the vestibular node or translabyrinthine transection of the vestibular-cochlear nerve root (in cases of grade III-IV hearing loss). These operations completely destroy the auditory function in the operated ear, but repeated attacks of labyrinthine disease are not excluded, but in a significantly reduced form.

Currently, methods of surgical intervention on the vestibular cochlear nerve have been developed and are being used, with the isolation and intersection of only its vestibular portion, using the technique of intraoperative monitoring of the impulses of this nerve and surgery under video control.

In addition, the operation of microvascular decompression of the vestibular nerve with extracranial access through the MMU is widely used abroad. The essence of the operation is the removal of sympathetic fibers and arterioles that encircle the nerve trunk. The high efficiency of this operation is noted in foreign literature.

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Non-surgical blocking and destructive methods of treatment of Meniere's disease

L. Coletli's method (1988). After removal of the stapes base and the outflow of endolymph, a crystal of table salt is placed in the vestibule, and the defect in the window formed after removal of the stapes base is closed with a flap from the wall of the vein. According to the author, this method prevents the occurrence of new attacks, significantly reduces or eliminates tinnitus in the operated ear.

Method of cryosurgical destruction of the labyrinth W. House (1966)

This method of treatment consists of the impact on the membranous labyrinth in the projection of the space between the windows of the vestibule and the cochlea after preliminary thinning in this area of the section of the medial wall of the tympanic cavity for more effective impact of the cold factor using a special cryoapplicator. The effective temperature of the cooling agent is - 80 ° C with a double exposure of 1 min. According to the author, a positive result was obtained in 70-80% of cases.

Method of ultrasonic destruction of the labyrinth M.Arslana (1962)

G. Portmann and M. Portmann (1976) proposed a transmeatal route of ultrasound signal delivery at a maximum power of 1.25 W/cm2 ^, 2 sessions of 10 minutes per week, a total of 12 sessions. The results were assessed as very satisfactory.