Endolymphatic duct blockage for refractory Ménière’s disease: assessment of intraoperative CSF leak on short-term surgical outcomes

Abstract

Background: Endolymphatic sac decompression has shown limited success for the treatment of Ménière’s disease (MD). We have published a novel technique with very promising results for the treatment of refractory MD: the Endolymphatic Duct Blockage (EDB) with two titanium clips. One of the challenges of this technique was an increased incidence of intraoperative Cerebrospinal Fluid (CSF) Leak.

Objective: To assess the effect of intraoperative CSF Leak on short-term surgical outcomes.

Methods: Retrospective comparative study in a tertiary care center (61 patients). MD patients who underwent EDB were included. Intraoperative CSF Leaks were documented. Surgical outcomes assessed were the presence of postoperative Benign Paroxysmal Positional Vertigo (BPPV), aural fullness, tinnitus, vertigo spells and pure tone average (PTA), speech discrimination scores (SDS) and bone conduction thresholds (BCT). Data were collected for these visits: preoperative, 1 week, 1 and 6 months postoperatively.

Results: Outcomes for the CSF Leak group (CSF +) (n = 22) were compared to remaining patient (CSF–) (n = 39). There was no significant difference in the occurrence of postoperative BPPV, aural fullness, tinnitus and vertigo spells. There was no significant difference in PTA, BCT or SDS between our groups at any visit.

Conclusions: Intraoperative CSF Leak may cause a temporary non-significant worsening of hearing in the first-month postoperatively without any difference at 6 months.

Chinese abstract

背景：内淋巴囊减压术治疗梅尼埃病（MD）的成功率有限。我们已经发表了一项新技术, 对治疗难治性MD的结果很有前景：带两个钛夹的内淋巴管阻塞（EDB）。这种技术面临的挑战之一是术中脑脊液（CSF）泄漏的发生率增加。

目的：评估术中CSF泄漏对短期手术结果的影响。

方法：在三级医疗中心进行回顾性比较研究（61例）。包括接受EDB的MD患者。记录术中CSF泄漏。评估的手术结果包括术后BPPV 的存在、耳闷涨感、耳鸣、眩晕和纯音平均值（PTA）、语音辨别分数（SDS）和骨传导阈值（BCT）。为术前、术后1周、1个月和6个月的随访收集资料。

结果：将CSF泄漏组（CSF +）（n = 22）的结果与其余患者（CSF-）（n = 39）进行比较。术后BPPV、耳闷涨感、耳鸣、眩晕方面无显著差异。在任何随访中, 两组之间的PTA、BCT或SDS没有显著差异。

结论：术中CSF泄漏可能导致术后第一个月的听力暂时性微度降低, 6个月时无任何差异。

Keywords:

• Ménière’s disease
• endolymphatic duct
• endolymphatic sac
• decompression
• CSF
• leak
• endolymphatic duct blockage

Disclosure statement

No potential conflict of interest was reported by the authors.