Endolymphatic sac decompression versus endolymphatic duct blockage in patients with saccular and utricular hydrops, as evidenced by MRI

Overview & Synopsis

Objectives: Endolymphatic sac surgery (ESS) is used worldwide to shunt the excess of endolymph liquid in the saccule in Meniere’s disease (MD). Recently, a new surgical technique has been proposed using an endolymphatic duct blockage (EDB). The aim of this work was to evaluate these procedures faced with preoperative and postoperative MRI with delayed acquisition, using the so-called hydrops protocol. Methods: In this retrospective study, the 3D-FLAIR sequences (4 hours after contrast media injection) were used before and after surgery in 17 MD patients. Nine patients who underwent endolymphatic sac decompression (ESD) and 8 who underwent EDB were retrospectively included in our study. Two radiologists independently graded saccular hydrops (SH) and utricular hydrops (UH) before and after surgery based on the latest published imaging classifications. Results: All MD patients presented with pre-operative saccular or utricular hydrops, as evaluated using MRI. In ESD group, 2 patients presented with SH disappearance after surgery while vertigo attacks were controlled in all patients. In EDB group, 2 patients also presented with SH decrease yet vertigo attacks were controlled for only one patient. In ESD group, 8 patients (89%) no longer experienced vertigo attacks compared to only 3 patients (37.5%) improved in the EDB group. Conclusions: A careful selection of MD patients using MRI has allowed ESD to be efficient in almost all cases with pre-operative saccular hydrops, by contrast with EDB technique. There was no correlation between the imaging results after surgery and the control of vertigo.