Three-Dimensional Magnetic Resonance Imaging Reveals the Relationship Between the Control of Vertigo and Decreases in Endolymphatic Hydrops After Endolymphatic Sac Drainage With Steroids for Meniere's Disease
Three-Dimensional Magnetic Resonance Imaging Reveals the Relationship Between the Control of Vertigo and Decreases in Endolymphatic Hydrops After Endolymphatic Sac Drainage With Steroids for Meniere's Disease
复制标题
DOI：
10.3389/fneur.2019.00046
复制
发表时间：
2019-02-04
影响因子：
3.4
通讯作者：
Kitahara, Tadashi
中科院分区：
文献类型：
--
作者：
Ito, Taeko;Inui, Hiroshi;Kitahara, Tadashi
梅尼埃病是一种常见病，表现为反复发作的眩晕和耳蜗病症状。1938年，梅尼埃病的病理首次被报道涉及内淋巴积水。内淋巴囊被认为具有维持内耳静水压力和内淋巴内稳态的作用。作为治疗顽固性梅尼埃病的一种手术方法，采用内淋巴囊引流加内淋巴囊内应用大剂量类固醇的方法来控制内淋巴积液，保护或改善内耳功能。在本研究中，为了观察手术的效果，我们在静脉注射Gd后4h，即手术前和手术后2年，使用3Tesla磁共振成像(MRI)计算内淋巴间隙大小。为了揭示内淋巴间隙的情况，我们半自动构建了三维MR图像，并对内耳全液体间隙和内淋巴间隙的三维图像进行了融合。图像融合后，计算总液体间隙和内淋巴间隙的体积。术后2年，20例患者中有16例(80.0%)眩晕/眩晕减轻，内淋巴体积与内耳总液体空间之比减小。内淋巴囊引流加内淋巴囊内应用大剂量类固醇可控制眩晕、头晕，减少内淋巴积液。这些结果表明，内淋巴囊引流是治疗难治性梅尼埃病的良好选择。此外，内耳体积的测量可能有助于确认梅尼埃病的治疗效果。
Meniere's disease is a common disease, that presents with recurrent vertigo and cochlear symptoms. The pathology of Meniere's disease was first reported to involve endolymphatic hydrops in 1938. The endolymphatic sac is thought to have a role to keep the hydrostatic pressure and endolymph homeostasis for the inner ear. As a surgery for intractable Meniere's disease, endolymphatic sac drainage with intraendolymphatic sac application of large doses of steroids is performed to control the endolymphatic hydrops and preserve or improve inner ear function. In the present study, to observe the effect of this surgery, we calculated the endolymphatic space size using 3-Tesla magnetic resonance imaging (MRI) 4 h after intravenous injection of gadolinium enhancement at two time points: just before surgery and 2 years after. To reveal the condition of the endolymphatic space, we constructed three-dimensional MR images semi-automatically and fused the three-dimensional images of the total fluid space of inner ear and the endolymphatic space. After fusing the images, we calculated the volume of the total fluid space and endolymphatic space. Two years after surgery, 16 of 20 patients (80.0%) showed relief from vertigo/dizziness and reductions in the ratio of the volume of the endolymphatic size to the total fluid space of inner ear. Endolymphatic sac drainage with intraendolymphatic sac application of large doses of steroids could control vertigo/dizziness and decrease the endolymphatic hydrops. These results indicate that endolymphatic sac drainage is a good treatment option for patients with intractable Meniere's disease. In addition, volumetric measurement of inner ear volume could be useful for confirming the effect of treatments on Meniere's disease.