Laberintectomía quirúrgica / Surgical labyrinthectomy

El tratamiento quirúrgico del vértigo se puede dividir en dos grandes grupos: no ablativos y ablativos, dentro de éstos últimos se encuentra la laberintectomía quirúrgica, técnica con la cual se produce cofosis. Su principal indicación es la sintomatología vestibular periférica invalidante, unilateral, que no mejora con medidas farmacológicas ni con terapia psiquiátrica, asociado a hipoacusia sensorioneural severa a profunda. Existen dos tipos de abordajes para realizar la laberintectomía quirúrgica: transmastoidea y transcanal, siendo la primera el gold standard para eliminar la función vestibular. Se presentarán dos casos clínicos de pacientes sometidos a estos procedimientos, uno por vía transmastoidea y otro por vía transcanal.

The surgical treatment of vertigo can be classified into two main groups: non-ablative and ablative. The surgical labyrinthectomy is an ablative treatment in which no hearing is preserved. Its main indication is the disabling peripherical and unilateral vestibular symptoms that do not improve with pharmacological measures or with psychiatric therapy, in patients with severe to profound sensorineural hearing loss. There are two types of approaches for labyrinthectomy, transmastoid and transcanal, the first is the gold standard to eliminate the vestibular function. Here, we present two cases of patients undergoing these procedures, one by transmastoid approach and the other by transcanal approach.

Tratamento cirúrgico da doença de Ménière por meio de Shunts labirínticos: Passado e presente / Surgical treatment of Meniere disease via labyrinth Shunt: Past and present

Introdução: As cirurgias dos shunts endolinfáticos empregadas para o tratamento da vertigem na doença de Ménière incapacitante permanece um tópico controverso. Portmann, em 1926, foi o primeiro a executar a cirurgia, incisando o saco endolinfático com o objetivo de diminuir a pressão endolinfática da orelha interna. Planejadas para criar uma fístula que conecte o espaço endo e perilinfático, as saculotomias foram descritas por FICK em 1964, por CODY em 1969 e por SCHUKNECHT (cocleossaculotomia) em 1982, entretanto foram paulatinamente abandonadas devido à alta incidência de perda auditiva. Uma nova e promissora opção cirúrgica dos shunts, em caráter experimental, é a utriculostomia, realizada por LAVINSKY em 1999. Objetivo: Realizar uma revisão da literatura sobre as principais técnicas cirúrgicas dos shunts endolinfáticos empregados no tratamento da doença de Ménière, seus resultados e o que há de avanços no entendimento desses procedimentos. Método: Com base nos dados da literatura, são discutidas as principais técnicas cirúrgicas dos shunts endolinfáticos e sua racionalidade no tratamento da doença de Ménière incapacitante. Conclusão: Existe muita controvérsia sobre a efetividade dos procedimentos cirúrgicos dos shunts endolinfáticos para o tratamento da doença de Ménière incapacitante, e muitos deles causam danos à orelha interna. A cirurgia experimental utriculostomia, portanto, parece-nos uma opção promissora. Futuras pesquisas poderão fornecer a resposta para essa questão...

Introduction: The surgerys of the endolymphatic shunt are employed in the treatment of the vertigo of Meniere disease disabling, remains a controversial topic. Portmann in 1926, was the first to perform the surgery, incising the endolymphatic sac aimming the decrease of the endolymphatic pressure of the inner ear. Planned to create a fistula that connects the endo and perilymphatic space, the sacculotomy were described by Fick in 1964, by Cody in 1969 e by Schuknecht (cochleosacculotomy) in 1982, however they were gradually abandoned because of the high incidence of hearing loss. A new and promising surgery option of shunt, still experimental is utriculostomy, performed by LAVINSKY in 1999. Objective: Make a review of literature about the main surgical techniques of endolymphatic shunt, used in the treatment of Meniere disease, its results and the advance in the understanding of these procedures. Methods: Based on the literature data, the main surgical techniques of endolymphatic shunt are discussed and its rationality in the treatment of Meniere's disabling disease. Conclusion: There are a lot of controversy over the effectiveness of surgical procedures of endolymphatic shunt for the treatment of Meniere's disabling disease, and a lot of them damage the inner ear. The experimental surgery of utriculostomy, so it seems, a promising option. Future research can give an answer to this matter...

Role of ecochg in identification and management of endolymphatic hydrops in stapedial and cochlear otosclerosis

Otosclerosis is accompanied with vestibular symptoms in many cases. In 1968 black et al, discovered the co existence of endolymphatic hydrops with Otosclerosis. Many researchers tried to find out correlation between air conduction thresholds and endolymphatic potentials [Gibson and Arenberg,1997; soliman et al, 1999], but few research work tried to find out such a correlation with bone conduction thresholds. This research work was designed to study changes in endolymphatic potentials in conductive and mixed hearing loss associating vertigo in otosclerotic patients. Moreover, to correlate between the bone conduction thresholds and the electrocochleographic potentials ratio in both groups. 40 patients diagnosed as having Otosclerosis were included in the current study 20 patients with Conductive hearing loss and complaining of vertigo [GC]. 20 patients with mixed hearing loss and complaining of vertigo [GM] with 20 normal subjects acted as a control group [GN]. Results of the current study showed a high incidence of endolymphatic hydrops in patients with Otosclerosis. In spite of the increased incidence of endolymphatic hydrops in patients with cochlear Otosclerosis, than in patients with purely stapedial Otosclerosis, no statistically significant difference could be reached. Moreover, no direct correlation could be elicited between bone conduction thresholds and SP/AP amplitude ratio in either group

Tratamiento quirúrgico del vértigo: revisión bibliográfica / Surgical treatment of vertigo: a review

Se hace una revisión bibliográfica crítica de los procedimientos quirúrgicos usados para curar el síntoma vértigo, con objeto de aclarar sus indicaciones en función de resultados y de efectos nocivos. Las conclusiones a que se llegó fueron las siguientes: 1. En el vértigo producto de fístula perilinfática, se debe intervenir quirúrgicamente tan pronto sea diagnosticada y aún en casos de que solo exista una razonable sospecha. 2. En el vértigo postural paroxístico benigno incapacitante y resistente a tratamiento médico y rehabilitación física, se puede intervenir con obliteración del conducto semicircular posterior, informando al paciente, de preferencia por escrito, que existe riesgo, aunque poco probable, de que aparezca hipoacusia y acúfeno. 3. El vértigo ocasionado por la enfermedad de Meniére o por otros padecimientos, en caso de ser incapacitante y no susceptible a tratamiento médico, debe intervenirse siguiendo dos criterios: Cuando la audición ha disminuido hasta el punto de ya no ser útil, se puede emplear la gentamicina intratimpánica o la derivación del saco endolinfático; si estas fracasan, debe efectuarse laberintectomía. Cuando hay buena audición, o audición recuperable con auxiliar auditivo se puede hacer derivación del saco endolinfático; si ésta fracasa, neurectomía vestibular. 4. Hay razones para ser escéptico sobre la existencia y sobre la posibilidad diagnóstica del vértigo como producto de compresión vascular al tronco del nervio octavo, por lo que la descompresión microvascular del nervio debe considerarse como en fase experimental, y no efectuarse en ambiente clínico.

Utriculostomia: apresentaçäo de uma nova técnica para tratamento cirúrgico da vertigem / Utriculusstomy: presentation of a new technique for the treatment of vertigo

Objetivo: apresentar uma nova técnica alternativa para o tratamento cirúrgico de vertigem causada pela Doença de Menière, a utriculostomia, desenvolvida no HCPA...

Vértigo posicional paroxístico benigno: maniobras diagnósticas y terapéuticas

El vértigo posicional paroxistico benigno, es la causa más frecuente de vértigo, responsable hasta del 20 porciento de todos los casos de vértigo y de por lo menos la mitad de todos los casos de vértigo periferico. Si se sabe cómo diagnosticar esta frecuente enfermedad a menudo es posible evitar un elaborado e innecesario trabajo de diagnóstico y resolver los síntomas de manera precoz

Surgery for intractable vertigo: Chiang Mai experience.

If medical therapy fails (6-12 months or more), careful consideration of surgical therapy should be followed with; the patient's hearing, severity of symptoms, age, and occupation. Cochleosacculotomy is reserved for elderly Meniere's patients with poor health, poor hearing and good vestibular function. Endolymphatic sac shunt should be considered as the first procedure for disabled Meniere's patients with aidable hearing and may also be used in those patients with bilateral Meniere's disease. Retrolabyrinthine vestibular nerve section (RLVNS) is indicated for patients with disabling vertigo and normal or aidable hearing. It could be done for all peripheral vertigo and for failed endolymphatic sac procedure. A destructive procedure, such as labyrinthectomy, should be a procedure of choice in a patient who presents with peripheral incapacitating vertigo and nonserviceable hearing loss in the solely affected ear. Again, patients with failed cochleosacculotomy, endolymphatic shunt then go on to receive either labyrinthectomy or RLVNS, based on residual hearing. To obtain a satisfactory surgical result, the surgeon must be precise in selecting the patient with the right disease at the right time.

Cirugía del vértigo : conceptos anatómicos y clínicos / Surgery for vertigo. Anatomic and clinical concepts

El proposito actual en el tratamiento quirurgico del vertigo esta basado en gran parte en el conocimiento anatomico y la diseccion del hueso temporal. Se expone la anatomia quirurgica del hueso temporal y del angulo ponto cerebeloso, seguido por una revision clinica del examen fisico del paciente con vertigo y de un recordatorio de las enfermedades mas comunes que causan vertigo, las cuales son suceptibles de tratamiento quirurgico. Finalmente se mencionan las indicaciones y los resultados de las distintas operaciones existentes de acuerdo a la literatura revisada.

Aportes para un tratamiento racional de vertigo / Contributions for a rational treatment of vertigo

Se presenta una clasificacion del vertigo segun su localizacion antomica. su duracion y sus caracteristicas clinicas; se hace un resumen de las drogas ototxicas de uso frecuente y de las que, sin serlo, pueden producir mareo; se discuten diversos aspectos del manejo de esta entidad y se propone un tratamiento racional enfocado sobre cinco aspectos principales, a saber: preventivo, de rehabilitacion, psicoterapeutico, farmacologico y quirurgico

A classification of vertigo according to its anatomy collocation, duration and clinical characteristics is presented along with a summary of the most frequently employed ototoxic drugs and of those that, not being ototoxic, can produce dizziness. We discuss different aspects concerning the management of this entity. specially those within the scope of the general.