Evolution in surgical management of superior canal dehiscence syndrome

Shaia, Wayne T.; Diaz, Rodney C.

doi:10.1097/moo.0b013e328364b3ff

Cited by 40 publications

(44 citation statements)

References 8 publications

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“…We can hypothesize that these patients may benefit from a different or simply less invasive surgical approach. In a recent review on the progression of surgical techniques used to repair SSC dehiscence, Shaia’s group summarized recent findings regarding transmastoid, endoscopic middle cranial fossa and transcanal approaches [13]. The latter and newest technique relies on the “third mobile window” to justify that reinforcement of any one of the three windows might improve SCDS.…”

Section: Discussionmentioning

confidence: 99%

“…The traditional middle cranial fossa approach has been shown by our group and others to result in a significant improvement of patients’ preoperative symptoms [12]. Nevertheless, performing a craniotomy is not without risk, as complications such as facial paralysis, cerebrospinal fluid leak and intracranial bleeding can occur [13]. Thus, many otolaryngologists question the idea of subjecting patients to the risks of a surgery, especially when the complaints are limited to a few tolerable symptoms.…”

Section: Introductionmentioning

confidence: 99%

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Common Features in Patients With Superior Canal Dehiscence Declining Surgical Treatment

et al. 2015

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BackgroundSuperior canal dehiscence (SCD) is a benign condition in which a surgical treatment may be considered depending on the patients’ tolerance of their symptoms. In this study, we aim to identify driving factors behind the patients’ choice of a surgical management over watchful waiting.MethodsSixty-two patients with cochlear and/or vestibular symptoms and a temporal bone high-resolution CT (HRCT) scan showing SCD were included in the study. All patients have been offered either surgical management or watchful waiting.ResultsOf these, 28 elected surgery and 34 declined it. The operated group showed more cochlear (6.6 vs. 2.4) symptoms than the non-operated group (P < 0.001) except for hypoacousis, but no significant difference (P = 0.059) was found for the number of vestibular symptoms between both groups (3.4 vs. 1.1). Footstep and eating hyperacousis were both present in 57.1% of operated vs. 3% of non-operated patients (P < 0.001). Oscillopsia with effort and with walking was found in 50% and 35.7% of operated patients, respectively, but none in the non-operated group (P < 0.001). Hearing tuning fork at malleolus and Valsalva and pneumatic speculum induced vertigo showed a statistically significant difference between the two groups (P = 0.003, P < 0.001, P = 0.010 respectively). Cervical vestibular-evoked myogenic potential (cVEMP) thresholds, air and bone conduction thresholds, and mean air-bone gap (ABG) were similar in the two populations (P > 0.05). The average dehiscence size was 4.7 mm (2.0 - 8.0 mm) and 3.8 mm (1.3 - 7.7 mm) in the operated and non-operated patients, respectively (P = 0.421).ConclusionsThe natures of cochleovestibular signs and symptoms were shown to be key factors in patients’ choice of a surgical management whereas paraclinical tests seem to be less significant in the patients’ decision for a surgical treatment.

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Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Common Features in Patients With Superior Canal Dehiscence Declining Surgical Treatment

et al. 2015

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“…Both methods are now used routinely. There are several access routes, of which access via the middle cranial fossa and the transmastoid should be emphasized again [41,42]. Postoperatively, an improvement in conductive hearing loss and hypo-functioning of the obliterated semicircular canal with normal functioning of the two remaining ipsilateral semicircular canals is seen [43,44].…”

Section: Therapymentioning

confidence: 97%

Superior canal dehiscence syndrome in children – A case report

Wenzel¹,

Stuck²,

Servais³

et al. 2015

International Journal of Pediatric Otorhinolaryngology

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“…first described SCD in 1998 1 , they reported success in managing SCD symptoms by repairing the defects via middle-fossa craniotomy (MFC) approach and occluding the bony defect, a technique which is still used today. 5–15 Although currently debated in the literature 8–11 , studies indicate that occlusion of the SSC is associated with lower recurrence of symptoms compared to resurfacing or “capping” repairs. 3,4,8 However, despite the durability of SCD occlusion, variable outcomes and complications can occur.…”

Section: Introductionmentioning

confidence: 99%

Characteristics of Wax Occlusion in the Surgical Repair of Superior Canal Dehiscence in Human Temporal Bone Specimens

Cheng

Kozin

Remenschneider

et al. 2016

Otology &Amp; Neurotology

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Hypothesis Superior canal dehiscence (SCD) repair using surgical bone wax may result in variable outcomes if large wax volumes are applied. Background SCD is a disorder characterized by a pathologic defect in the bony labyrinth of the superior semicircular canal (SSC), resulting in vestibular and/or auditory symptoms. Repair of SCD using bone wax can provide symptomatic relief, but surgical outcomes are variable. These observations may be associated with the inconsistency in the position and extension of intralabyrinthine bone wax during surgical repair. Methods A pathological model of SCD was created using cadaveric human temporal bones and a microdrill. Defects in the arcuate eminence 0.5–3.5 mm in length were repaired using surgical occlusion with bone wax. The volume of wax used in the repair was quantified. The position of bone wax was evaluated by direct visualization and imaging (computed tomography [CT]). To visualize wax on CT, specimens were repaired using radiopaque wax. Results Exceedingly small volumes of bone wax (3.0–5.0 mm2) reliably occluded the canal lumen. Multiple wax applications resulted in extension into the common crus and ampulla. The length of this extension was related to the number of applications. Conclusions Repair of SCD with bone wax occludes the bony defect completely in most cases. Wax can extend along the lumen of the superior canal beyond the limits of the dehiscence to reach the sensory neuroepithelium of the vestibular end organs. Limiting the number of wax applications is essential to avoid inadvertent injury to the delicate neurosensory systems.

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Evolution in surgical management of superior canal dehiscence syndrome

Cited by 40 publications

References 8 publications

Common Features in Patients With Superior Canal Dehiscence Declining Surgical Treatment

Common Features in Patients With Superior Canal Dehiscence Declining Surgical Treatment

Superior canal dehiscence syndrome in children – A case report

Characteristics of Wax Occlusion in the Surgical Repair of Superior Canal Dehiscence in Human Temporal Bone Specimens

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