Abstract：
OBJECTIVE: The aim was to evaluate endolymphatic hydrops in patients with severe Ménière\'s disease (MD) before and after vestibular neurectomy to verify if vestibular denervation results in hydrops regression.
METHODS: Magnetic resonance imaging was performed after intravenous gadolinium injection in twenty patients with unilateral definite MD before and after the vestibular neurectomy. Clinical symptoms and audiovestibular tests were evaluated. Follow-up intervals ranged from 18 to 35 months after the surgery.
RESULTS: Endolymphatic hydrops were visualized in all patients in the preoperative scans. After the vestibular neurectomy, all patients presented a complete resolution of vertigo episodes. Regression of the endolymphatic hydrops was observed in 35% and 15% of cases analyzing cochlea and vestibule, respectively. In 71.43% of patients with utricular herniation into the lateral semicircular canal, withdrawal of the hernia was visualized. Asymmetrical contrast enhancement in the cochlea regressed in 17.64% of cases. Analyzing all the parameters collectively, in 60% of patients, partial regression of at least one of the radiological signs was confirmed in the follow-up examination. No progression of the endolymphatic hydrops was visualized after the surgery in either the cochlea or the vestibule.
CONCLUSIONS: Vestibular neurectomy is an effective treatment, eliminating vertigo attacks and improving the quality of life in patients with MD. Magnetic resonance imaging of the inner ear allows visualization of changes in endolymphatic hydrops degree after treatment. Regression of the endolymphatic hydrops after vestibular neurectomy suggests that vestibular denervation may effectively halt the progression of the endolymphatic space dilatation and result in hydrops regression.
METHODS: Magnetic resonance imaging was performed after intravenous gadolinium injection in twenty patients with unilateral definite MD before and after the vestibular neurectomy. Clinical symptoms and audiovestibular tests were evaluated. Follow-up intervals ranged from 18 to 35 months after the surgery.
RESULTS: Endolymphatic hydrops were visualized in all patients in the preoperative scans. After the vestibular neurectomy, all patients presented a complete resolution of vertigo episodes. Regression of the endolymphatic hydrops was observed in 35% and 15% of cases analyzing cochlea and vestibule, respectively. In 71.43% of patients with utricular herniation into the lateral semicircular canal, withdrawal of the hernia was visualized. Asymmetrical contrast enhancement in the cochlea regressed in 17.64% of cases. Analyzing all the parameters collectively, in 60% of patients, partial regression of at least one of the radiological signs was confirmed in the follow-up examination. No progression of the endolymphatic hydrops was visualized after the surgery in either the cochlea or the vestibule.
CONCLUSIONS: Vestibular neurectomy is an effective treatment, eliminating vertigo attacks and improving the quality of life in patients with MD. Magnetic resonance imaging of the inner ear allows visualization of changes in endolymphatic hydrops degree after treatment. Regression of the endolymphatic hydrops after vestibular neurectomy suggests that vestibular denervation may effectively halt the progression of the endolymphatic space dilatation and result in hydrops regression.
摘要：
目的：目的是评估严重梅尼埃病（MD）患者在前庭神经切除术前后的内淋巴积水，以验证前庭神经支配是否导致积水消退。
方法：对20例单侧明确MD的患者，在前庭神经切除术前后进行静脉注射后进行磁共振成像。评估临床症状和听觉前庭检查。术后随访时间为18～35个月。
结果：术前扫描显示所有患者的内淋巴积液。前庭神经切除术后，所有患者的眩晕发作完全缓解.在分析耳蜗和前庭的病例中，有35％和15％观察到内淋巴积液的消退，分别。在71.43％的患者中，输尿管突出进入外侧半规管，可见疝气的撤出。在17.64％的病例中，耳蜗的不对称对比度增强消退。共同分析所有参数，在60%的患者中，在随访检查中确认了至少一种放射学体征的部分消退。手术后，耳蜗或前庭均未观察到内淋巴积液的进展。
结论：前庭神经切除术是一种有效的治疗方法，消除眩晕发作并改善MD患者的生活质量。内耳的磁共振成像可以显示治疗后内淋巴积水程度的变化。前庭神经切除术后内淋巴积水的消退表明前庭神经支配可以有效地阻止内淋巴空间扩张的进展，并导致积水消退。
方法：对20例单侧明确MD的患者，在前庭神经切除术前后进行静脉注射后进行磁共振成像。评估临床症状和听觉前庭检查。术后随访时间为18～35个月。
结果：术前扫描显示所有患者的内淋巴积液。前庭神经切除术后，所有患者的眩晕发作完全缓解.在分析耳蜗和前庭的病例中，有35％和15％观察到内淋巴积液的消退，分别。在71.43％的患者中，输尿管突出进入外侧半规管，可见疝气的撤出。在17.64％的病例中，耳蜗的不对称对比度增强消退。共同分析所有参数，在60%的患者中，在随访检查中确认了至少一种放射学体征的部分消退。手术后，耳蜗或前庭均未观察到内淋巴积液的进展。
结论：前庭神经切除术是一种有效的治疗方法，消除眩晕发作并改善MD患者的生活质量。内耳的磁共振成像可以显示治疗后内淋巴积水程度的变化。前庭神经切除术后内淋巴积水的消退表明前庭神经支配可以有效地阻止内淋巴空间扩张的进展，并导致积水消退。
