山东大学耳鼻喉眼学报 ›› 2020, Vol. 34 ›› Issue (5): 46-50.doi: 10.6040/j.issn.1673-3770.1.2020.061

• 临床研究 • 上一篇    下一篇

迷路后径路前庭神经切断术治疗难治性梅尼埃病75例

刘宇鹏,吴文瑾,何景春,郑贵亮,张青,杨军   

  1. 刘宇鹏, 吴文瑾, 何景春, 郑贵亮, 张青, 杨军上海交通大学医学院附属新华医院 耳鼻咽喉头颈外科/上海市耳鼻疾病转化医学重点实验室/上海交通大学医学院 耳科学研究所, 上海 200092
  • 收稿日期:2020-07-07 出版日期:2020-09-20 发布日期:2020-11-17
  • 基金资助:
    上海交通大学医工交叉重点项目(ZH2018ZDA11);上海交通大学医学院附属新华医院院级临床研究培育基金项目(17CSK03,18JXO04)

Therapeutic effectiveness of 75 cases of retrolabyrinthine vestibular neurectomy for intractable Menieres disease

To determine the therapeutic effectiveness of retrolabyrinthine vestibular neurectomy for intractable Menieres disease.MethodsClinical data of 75 patients with unilateral intractable Menieres disease who underwent retrolabyrinthine vestibular neurectomy were retrospectively investigated. Therapeutic effectiveness was analyzed, and the safety and reliability of the procedure was discussed. ResultsThe mean duration of the disease was 53.11±43.87 months. Preoperative pure tone average of 500 Hz, 1 000 Hz, 2 000 Hz, and 4 000 Hz was(63.71±16.85)dB HL. Two cases were stage Ⅱ, 34 cases were stage Ⅲ, and 39 cases were stage Ⅳ. Two stage Ⅱ patients were recurrent cases after endolymphatic sac decompression surgery. Intracranial infection in 1 case(1.3%), cerebrospinal fluid leakage in 4 cases(5.3%), temporal facial nerve palsy in 1 case(1.3%), incision infection in 2 cases(2.6%), and fat liquefaction in 3 cases(3.9%)were observed postoperatively. There was no case of intracranial hemorrhage or total deafness. Therapeutic effectiveness for relieving vertigo was level A in 73 cases and level B in 2 cases. ConclusionThe therapeutic effectiveness of retrolabyrinthine vestibular neurectomy for intractable Menieres disease is definite. Surgical risk and postoperative complications are controllable, and the quality of life can be significantly improved after surgery.   

  1. Key words: Menieres disease;
    Vertigo;
    Vestibular neurectomy;
    Hearing loss;
    Therapeutic effectiveness;
    Vestibular compensation
  • Received:2020-07-07 Online:2020-09-20 Published:2020-11-17

摘要: 目的 探讨迷路后径路前庭神经切断术治疗难治性梅尼埃病的手术安全性、可靠性、术后疗效。 方法 回顾性分析75例单侧难治性梅尼埃病患者行经迷路后径路前庭神经切断术的临床资料。 结果 75例患者平均病程(53.11±43.87)个月,术前500 Hz、1 000 Hz、2 000 Hz、4 000 Hz平均听阈(63.71±16.85)dB HL。听力分期Ⅱ期2例,Ⅲ期34例,Ⅳ期39例。Ⅱ期2例患者为内淋巴囊减压术后复发患者。术后颅内感染1例(1.3%)、脑脊液漏4例(5.3%)、暂时性面瘫1例(1.3%)、切口感染2例(2.6%)、切口脂肪液化3例(3.9%)。无颅内出血及术后即刻全聋的病例。术后眩晕疗效评定73例患者为A级,2例患者为B级。 结论 经迷路后前庭神经切断术疗效确切,风险与并发症可控,可显著改善患者生活质量。

关键词: 梅尼埃病, 眩晕, 前庭神经切断术, 听力下降, 疗效, 前庭代偿

Abstract: Objective To determine the therapeutic effectiveness of retrolabyrinthine vestibular neurectomy for intractable Menieres disease. Methods Clinical data of 75 patients with unilateral intractable Menieres disease who underwent retrolabyrinthine vestibular neurectomy were retrospectively investigated. Therapeutic effectiveness was analyzed, and the safety and reliability of the procedure was discussed. Results The mean duration of the disease was 53.11±43.87 months. Preoperative pure tone average of 500 Hz, 1 000 Hz, 2 000 Hz, and 4 000 Hz was(63.71±16.85)dB HL. Two cases were stage Ⅱ, 34 cases were stage Ⅲ, and 39 cases were stage Ⅳ. Two stage Ⅱ patients were recurrent cases after endolymphatic sac decompression surgery. Intracranial infection in 1 case(1.3%), cerebrospinal fluid leakage in 4 cases(5.3%), temporal facial nerve palsy in 1 case(1.3%), incision infection in 2 cases(2.6%), and fat liquefaction in 3 cases(3.9%)were observed postoperatively. There was no case of intracranial hemorrhage or total deafness. Therapeutic effectiveness for relieving vertigo was level A in 73 cases and level B in 2 cases. Conclusion The therapeutic effectiveness of retrolabyrinthine vestibular neurectomy for intractable Menieres disease is definite. Surgical risk and postoperative complications are controllable, and the quality of life can be significantly improved after surgery.

Key words: Menieres disease, Vertigo, Vestibular neurectomy, Hearing loss, Therapeutic effectiveness, Vestibular compensation

中图分类号: 

  • R764.33
[1] Jackler RK, Whinney D. A century of eighth nerve surgery [J]. Otol Neurotol,2001,22(3):401-416. doi:10.1097/00129492-200105000-00023
[2] 时海波, 殷善开. 前庭神经切断术治疗梅尼埃病[J]. 中国医学文摘(耳鼻咽喉科学),2008(5):266-267.
[3] Committee on Hearing and Equilibrium guidelines for the diagnosis and evaluation of therapy in Menières disease. American Academy of Otolaryngology-Head and Neck Foundation, Inc[J]. Otolaryngol Head Neck Surg,1995,113(3):181-185. doi:10.1016/S0194-5998(95)70102-8.
[4] Yates BJ, Bronstein AM. The effects of vestibular system lesions on autonomic regulation: observations, mechanisms, and clinical implications[J]. J Vestib Res, 2005, 15(3): 119-129.
[5] Tighilet B, Bordiga P, Cassel R, et al. Peripheral vestibular plasticity vs central compensation: evidence and questions[J]. J Neurol, 2019, 266(Suppl 1): 27-32. doi:10.1007/s00415-019-09388-9.
[6] Beraneck M, Idoux E. Reconsidering the role of neuronal intrinsic properties and neuromodulation in vestibular homeostasis[J]. Front Neurol, 2012, 3: 25. doi:10.3389/fneur.2012.00025.
[7] Lacour M, Helmchen C, Vidal PP. Vestibular compensation: the neuro-otologists best friend[J]. J Neurol, 2016, 263(Suppl 1): S54-S64. doi:10.1007/s00415-015-7903-4.
[8] Lacour M, Barthelemy J, Borel L, et al. Sensory strategies in human postural control before and after unilateral vestibular neurotomy[J]. Exp Brain Res, 1997, 115(2): 300-310. doi:10.1007/pl00005698.
[9] Arshad Q, Seemungal BM. Age-related vestibular loss: current understanding and future research directions[J]. Front Neurol, 2016, 7: 231. doi:10.3389/fneur.2016.00231.
[10] Noohi F, Kinnaird C, De Dios Y, et al. Deactivation of somatosensory and visual cortices during vestibular stimulation is associated with older age and poorer balance[J]. PLoS One, 2019, 14(9): e0221954. doi:10.1371/journal.pone.0221954.
[11] Chen BS, Roberts DS, Lekovic GP. Vestibular neurectomy for intractable Vertigo: case series and evaluation of role of endoscopic assistance in retrolabyrinthine craniotomy[J]. J Neurol Surg B Skull Base, 2019, 80(4): 357-363. doi:10.1055/s-0038-1670685.
[12] Kitahara T. Evidence of surgical treatments for intractable Menieres disease[J]. Auris Nasus Larynx, 2018, 45(3): 393-398. doi:10.1016/j.anl.2017.07.016.
[13] 于浩然, 杨军, 周欣. 梅尼埃病不同手术治疗方案的效果分析[J]. 临床耳鼻咽喉头颈外科杂志,2019,33(6):501-504. doi:10.13201/j.issn.1001-1781.2019.06.006. YU Haoran, YANG Jun, ZHOU Xin. The effect of surgical treatment on Menieres disease[J]. Journal of Clinical Otorhinolaryngology Head and Neck Surgery,2019,33(6):501-504. doi:10.13201/j.issn.1001-1781.2019.06.006.
[14] Lee HJ, Lee JM, Shim DB, et al. Is early progression to bilateral involvement in menières disease a poor prognostic indicator?[J]. And, 2019, 40(10): 1333-1338. doi:10.1097/MAO.0000000000002368.
[15] 李斐, 庄建华, 陈瑛, 等. 梅尼埃病不同听力分期中颈肌前庭诱发肌源性电位的差异[J]. 临床耳鼻咽喉头颈外科杂志, 2016(1): 9-12. doi:10.13201/j.issn.1001-1781.2016.01.003 LI Fei, ZHUANG Jianhua, CHEN Ying, et al. Difference of cervical vestibular evoked myogenic potentials in different audition stage of Ménière disease[J]. Journal of Clinical Otorhinolaryngology, 2016(1): 9-12. doi:10.13201/j.issn.1001-1781.2016.01.003.
[16] Kharkheli E, Japaridze S, Kevanishvili Z, et al. Correlation between vestibular evoked myogenic potentials and disease progression in ménières disease[J]. ORL J Otorhinolaryngol Relat Spec, 2019, 81(4): 193-201. doi:10.1159/000496088.
[17] Master AN, Flores JM, Gardner LG, et al. Anatomical Factors Influencing Selective Vestibular Neurectomy: A Comparison of Posterior Fossa Approaches[J]. J Neurol Surg B Skull Base, 2016,77(1):19-23. doi: 10.1055/s-0035-1556876.
[18] Kitamura K, Miyata M, Wanamaker HH, et al. Vestibular neurectomy: a histological and clinical study of results[J]. J Laryngol Otol,1996,110(3):211-215.doi: 10.1017/s0022215100133225.
[19] 赵志勇. 经迷路后入路和经枕下乙状窦后入路对桥小脑角显露程度和损伤程度的综合评价[D].兰州:兰州大学,2007.
[20] Alarcón AV, Hidalgo LO, Arévalo RJ, et al. Labyrinthectomy and vestibular neurectomy for intractable vertiginous symptoms[J]. Int Arch Otorhinolaryngol, 2017, 21(2): 184-190. doi:10.1055/s-0037-1599242.
[21] Eisenman DJ, Speers R, Telian SA. Labyrinthectomy versus vestibular neurectomy: long-term physiologic and clinical outcomes[J]. Otol Neurotol, 2001, 22(4): 539-548. doi:10.1097/00129492-200107000-00022.
[22] 赵毅涛, 杨铁毅, 张岩. 手术后切口脂肪液化防治的研究进展[J]. 医学综述, 2016, 22(1): 97-101. doi:10.3969/j.issn.1006-2084.2016.01.028. ZHAO Yitao, YANG Tieyi, ZHANG Yan. Research progress of treatment and prevention of postoperative fat liquefaction of the incision[J]. Medical Recapitulate, 2016, 22(1): 97-101. doi:10.3969/j.issn.1006-2084.2016.01.028.
[23] McElveen JT Jr, Shelton C, Hitselberger WE, et al. Retrolabyrinthine vestibular neurectomy: a reevaluation[J]. Laryngoscope, 1988, 98(5): 502-506. doi:10.1288/00005537-198805000-00005.
[24] Moody-Antonio S, House JW. Hearing outcome after concurrent endolymphatic shunt and vestibular nerve section[J]. Otol Neurotol, 2003, 24(3): 453-459. doi:10.1097/00129492-200305000-00016.
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