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Arquivos Internacionais de Otorrinolaringologia 2011; 15(04): 501-508
DOI: 10.1590/S1809-48722011000400015
Review Article
Thieme Publicações Ltda Rio de Janeiro, Brazil

Surgical treatment of Meniere disease via labyrinth Shunt: Past and present

Tratamento cirúrgico da doença de Ménière por meio de Shunts labirínticos: Passado e presente
Francisco Carlos Zuma e Maia
1   Doctor in Otorhinolaringology from Universidade Federal do Rio Grande do Sul (UFRGS). Guest Professor of the Discipline of Otorhinolaringology of the Surgery and Medicine College of Universidade Federal do Rio de Janeiro (UFRJ).
,
Alexandre Dolganov
2   Doctor in Neurology. Visiting Professor from Pontifícia Universidade Católica do Rio Grande do Sul (PUCRS).
,
Luiz Lavinsky
3   Post-Doctorate in Otorhinolaringology. Professor from the Medicine College of UFRGS.
› Author Affiliations
Further Information

Publication History

10 February 2010

29 May 2010

Publication Date:
12 February 2014 (online)

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Summary

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.

Resumo

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.

Keywords

Meniere disease - vertigo - endolymphatic sac

Palavras-chave

doença de Ménière - vertigem - saco endolinfático
 

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