Revision surgery after saccotomy for Meniere's disease: does it make sense?

Saccotomy is an established surgical treatment for Meniere's disease that involves exposing and opening the endolymphatic sac and draining the endolymph. However, in patients experiencing recurrent vertigo after saccotomy, it is questionable whether revision saccotomy should be recommended as opposed to more invasive procedures, such as neurectomy of the vestibular nerve. To determine the utility of revision saccotomy, we conducted a retrospective study of 29 patients undergoing this procedure for recurrent vertigo. Patient charts were reviewed for the re-occurrence of any vertiginous symptoms and outcomes with regard to hearing results and post-operative complications. An attempt was made to correlate vertigo status post-revision with surgical findings at the time of revision. After an average follow-up of 20 months, 18 patients (62%) were free of vertigo, and four patients (14%) had a significant decrease in the frequency and intensity of vertiginous attacks. Two patients (7%) relapsed after a vertigo-free period of 18 months, and five patients (17%) experienced no clinical improvement after revision surgery. In patients with a successful sac revision, a common finding at the time of revision was new bone formation in the endolymphatic sac area (n=11), which may have caused blocking of the endolymphatic drainage. Our results demonstrate that revision saccotomy should be considered for recurrent Meniere disease before other, more invasive, surgical options.