Noninvasive evaluation of the effect of endolymphatic sac decompression in Ménière's disease using magnetic resonance imaging.

CONCLUSIONS

This study is the first to demonstrate noninvasive evaluation of the effect of endolymphatic sac decompression (ESD) in Ménière's disease using magnetic resonance imaging (MRI).

OBJECTIVE

To evaluate the effect of ESD for the treatment of Ménière's disease by applying noninvasive intratympanic gadolinium (Gd) perfusion through the eustachian tube and three-dimensional fluid-attenuated inversion MRI (3D-FLAIR MRI).

METHODS

This was a prospective study. 3D-FLAIR MRI was performed with a 3 Tesla unit 24 h after intratympanic administration of Gd through the eustachian tube in five patients with intractable Ménière's disease before and 3 months after ESD, with a 2-year follow-up on the effect of ESD.

RESULTS

Gd was present in the perilymph of the inner ear in all the patients, which clearly displayed the endolymphatic space on 3D-FLAIR MRI with a visible borderline between the perilymph and the endolymph. According to the normal values for the endolymphatic space, four of five patients had a ratio of more than 26% in the cochlea, and three of five patients had a ratio of more than 41% in the vestibule preoperatively. All the patients had a ratio of less than 26% in the cochlea and 41% in the vestibule postoperatively. ESD was effective in reducing the incidence and severity of vertigo attacks with significant improvement in 60% of patients.