2, The bony covering of yas removed between the sigmoid sinus and the posterior canal , The superior edge of the endolymphatic sac is dentiiog; usually lies at or below Donaldson's line, which extends posteriorly ane of the horizental canal and osterior ganal puny extn acne oud gh ey Ly hob, whe a at Dele FIGURE 04-2 + Paparelia technique for tendolymphatic mastoid shunting. A T-shaped plage ofsitgone is coed and places into a (gatinetton inthe endolymphatic sac to a Orage DatTTo ie Maso COTYTHE EAR FIGURE 34-3 ¢sEndolymphatic-subarachnoid shunt. A, After exponing and SoU TR atanT cal Sri sheieorane ss, the THpiiel Wal rte cad ls Inelosd ts oper ns lnteral prtornaton ot tis basal cistern. Dissection in'the cistern is carried out bluntly to avoid venous injury.’B, A silicone (Silastic®) shunts inserted to maintain drainage path betwéen thejendolymphatic sac and the basal cistern, ‘The lateral endolymphatic sac should be carefully closed with a fascia att to prevent cerebrospinal ld leie ‘success was absence of definitive vertigo spells, even if hear- ing worsens. Pillsbury et al. have argued that the shunt group would have had a significantly better outcome if patients who had success at relief of vertigo but worse hearing were consid. ered failures.” It was also not clear which data—preoperative, postoperative, or the difference between—were used to compare the groups in the Thomsen etal. study." A more recent analysis i i test to compare the preoperative used the Wilcoxon signed ran| . ? and postoperative groups. From this new analysis, the shunt jas found to achieve superior control of vertigo, tinnitus, and