[The value of saccotomy in Menière disease. A long-term analysis of 42 cases].
METHODS
Saccotomy is well known to be a specific alternative treatment for patients suffering from conservatively intractable Meniere's disease. In a long-term study, we investigated the results in hearing and vertigo after this operation and evaluated the subjective contentment of our patients. For the first time, we focused on the influence of an intraoperatively observed fibrotic narrowing (11 cases) of the endolymphatic sac ("sac fibrosis") on these results.


RESULTS
We found complete restitution or significant improvement of the typical vertigo attacks after saccotomy in more than 80% of the cases with a normally shaped endolymphatic sac as determined microscopically during operation. In the cases with sac fibrosis, however, we saw a considerable reduction of this percentage to about 36%. Regardless of the presence of sac fibrosis, 50% of our patients showed progressive hearing loss in the operated ear after saccotomy. The postoperative hearing remained unchanged in about 25% of the cases. The contentment of the patients depended mostly on the postoperative vertigo and not on the hearing.


CONCLUSIONS
We consider a microscopically normally shaped and wide saccus endolymphaticus to be a very important prognostic factor for the success of saccotomy. Consequently, preoperative selection of patients with sac fibrosis, for example, with high-resolution MRI, appears to be advisable.
Wilschowitz
M
M
HNO-Universitätsklinik Hamburg-Eppendorf, Martinistrasse 52, 20246 Hamburg. wilschowitz@aol.com
Sanchez-Hanke
M
M
Ussmüller
J
J
D000293:Adolescent; D000328:Adult; D000368:Aged; D002648:Child; D004712:Endolymphatic Sac / Q000503:physiopathology / Q000601:surgery*; D005260:Female; D005355:Fibrosis; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D008575:Meniere Disease / Q000503:physiopathology / Q000601:surgery*; D008875:Middle Aged; D016896:Treatment Outcome