Surgical anatomy of the endolymphatic sac

At present several different surgical modalities are available to the surgeon who is about to relieve dizzy patients of their vertigo. Although the majority of these procedures belong to the destructive category, endolymphatic sac-mastoid shunting is a relatively harmless and nondestructive procedure. The success of such an operation is, however, dependent on the fact that the surgeon really identifies and penetrates the endolymphatic sac lumen. This is probably not always the case, and the present article describes the large variability seen in the surgical anatomy of the endolymphatic sac. In some cases there is no extratemporal extension of the sac at all, which, of course, makes it impossible to identify and penetrate the sac. The large variability among individual cases is described and discussed.