Postnatal Development Of The Stromal Fibers Of The Pancreas Of Albino Rat:

Gamal Mohamed Hagras

Under Meniere’s disease we have mentioned the main aspectsof clinical picture and diagnosis, as well as a short account onits medical treatment.The major surgical procedures for Meniere’s disease werereviewed in more detail and these are:Endolymphatic sac surgery, with an account on the surgicalanatomy of the ELS, the indication of which seemed to varyfrom one surgeon to another and so did the unpredictableresults.The surgical technique of each of the three main methodswas discussed along with the postoperative complications,while no variation in results were obtained.Labyrinthectomy, which, unlike ELS surgery, is a destructiveprocedure of the labyrinth was discussed along with its indicationsand techniques.Results here were more positive than those of the ELS surgeryin controlling vertigo.Slightly better results were obtained by the transcanal labyrinthectomywith cochleovestibular neurectomy, otherwise differencein technique and route of labyrinthectomy gave no variationIn results. Besides sacrifice of hearing, complication rate hereis higher and more serious than in ELS surgery.Vestibular neurectomy was outlined with its indications andcontraindications. It gave better results in control of vertigothan ELS surgery, while hearing conservation results werethe same in both. This procedure carries a higher risk ofcomplications due to its intracrnial route, thus its applicationis better to be followed by a trial of ELS surgery.Sacculotomy . is a drainage procedure of endolymph into perilymph,same idea as ELS drainage, but it is complicated bya higher risk of postoperative hearing loss, with the sameor even inferior control onvertigo.It is thus conserved to elderly patients with unilateral incapacitatingMeriere’s disease as a trial prior to labyrinthectomy.Ultrasonic destruction of the vestibular labyrinth is a techniqueof limited use and uncontrol able outcome with a risk of complicationswhich overweigh its value.The results with most surgeons are unsatisfactory with highincidence of recurrence of vertigo, of loss of cochlear function,or both.Cervical sympathectomy, which is based on the vascularaetiology theory of Meniere’s disease and is applied at aremote site from the ear, is useful as a trial prior to other~_. __ . ---93-conservative procedures when hearing is to be preserved,mainly in bilateral Meniere’s disease.The risk of hearing loss is negligible, but results of controlof vertigo are less satisfactory (50 % control after 2 years).It is still not decided as to which surgical procedure is bestfor treatment of Meniere’s disease, as none is directed to theelimination of the aetiological factors which are still uncertain.So it is left to each surgeon to do the operation that gives thebest results in his own experience.Under acoustic neuroma, we have reviewed the anatomy ofthe ViII cranial nerve, pathology and physiopathology of the tumor,along with the clinical picture of the condition. Emphasis wasmade on the methods of investigation especially the radiologicalones, as it is very important, besides confirming the diagnosisof the tumor, to estimate its size in order to select the correctsurgical approach and to safeguard against surgical risks, especiallywith large tumors. Also prognosis of hearing preservation is directlydependent on the tumor size.The three main surgical approaches were discussed as fortheir indications, advantages and disadvantages, technique, complicationsand results.,--’-; ---------_.-911-The translabyrinthine approach is the one mainly done byotosurgeons, while the suboccipital approach, although mainlydone by neurosurgeons in the past, is being recently done in combinationwith the otosurgeon. Advantages of each of the aboveapproaches over the other were discussed along with their indications,techniques, complications and results.The middle fossa approach for acoustic neuromas besideshaving very few indications, has less advantages than the othertwo mentioned above.Under benign paroxysmal positional vertigo, a comment wasgiven on its aetiological theory, clinical picture and diagnosis.Technique of neurectomy of the nerve to the posterior canalampulla (Singular neurectomy), which is the surgical treatmentof choice for cases resistant to conservative medical management,was discussed along with its indications, complications and results.Under labyrinthitis, we discussed its stages, etiological factors,clinical picture and management. The later included surgicaldrainage of the labyrinth for which we gave a short account andreferred to (Chapter one) under labyrinthectomy for the technique.~~-- ----95-Finally perilymph fistula with its various causes and typeswas discussed. Emphasis was made on the spontaneous (barotraurnatic)fistulas, the etiological theory of which is discussed alongwith its clinical picture and investigations. The steps of . managementof spontaneous and traumatic perilymph fistulas (i.e. conservative,surgical exploration and repair of the fistula if found)are discussed in detail, along with their indications and results.