Middle cranial fossa approach for the repair of superior semicircular canal dehiscence is associated with greater symptom resolution compared to transmastoid approach

Nguyen, Thien; Lagman, Carlito; Sheppard, John P.; Yang, Isaac; Duong, Courtney; Prashant, Giyarpuram N.; Gopen, Quinton; Yang, Isaac

doi:10.1007/s00701-017-3346-2

Cited by 33 publications

(22 citation statements)

References 33 publications

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“…Efficacy in terms of symptom control was established with an improvement in all symptoms, except subjective hearing loss, in almost 80% of cases. 15 Our results are similar to those found in the literature with a control rate ranging from 75% for subjective hearing loss to 96% for fullness. In terms of maintained labyrinth function, some studies have not shown any significant worsening in cochlear and vestibular functions 16 whereas others reported significant worsening of up to 36% in high‐frequency hearing thresholds.…”

Section: Discussionsupporting

confidence: 91%

“…In terms of maintained labyrinth function, some studies have not shown any significant worsening in cochlear and vestibular functions 16 whereas others reported significant worsening of up to 36% in high‐frequency hearing thresholds. 15 Mean hearing thresholds were unchanged in our series but approximately 10% displayed sensorineural hearing loss at 4000 Hz.…”

Section: Discussionmentioning

confidence: 51%

“…In their systematic review, Nguyen et al found that auditory symptoms were more often improved after MFA compared to TMA (72% vs 59%) without any difference for vestibular symptoms. 15 However, fewer complications appear to have occurred with TMA and scenarios were less severe compared to MFA. 20 Depending on the anatomy, the authors advocate the transmastoid approach when the dehiscence is facing the superior petrous sinus.…”

Section: Discussionmentioning

confidence: 99%

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Surgical treatments of superior semicircular canal dehiscence: A single‐centre experience in 63 cases

Nieto

Gallois

Molinier

et al. 2021

Laryngoscope Investig Oto

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Objective: Different procedures have been described to treat superior canal dehiscence. The present study aims to describe the results obtained with middle fossa approach, transmastoid approach, and round window reinforcement in a large series of patients. Methods and Design:In this single-center retrospective study, we report the results of the procedures performed between 2006 and 2019 using the three main surgical approaches, middle fossa approach (MFA), transmastoid approach (TMA), and round window reinforcement (RWR). The outcome on cardinal cochlear and vestibular symptoms, audiometric results, and changes in cervical vestibular evoked myogenic potentials (cVEMPs) were analyzed. The patients were also interviewed 12 months to 13 years post-treatment to establish their overall satisfaction following surgery.Results: Sixty-three patients were divided into three groups: 42 MFA; 12 RWR; 9 TMA. Postsurgical control rates exceeded 80% for the majority of symptoms in the MFA and TMA groups, and ranged from 11.1% to 83.3% for the RWR group. Over 90% of MFA or TMA patients and 60% of the RWR cohort were satisfied overall with their treatment. Hearing thresholds were intact following surgery in the MFA and TMA groups. There was one case of profound postoperative deafness in the RWR group. Conclusion:MFA and TMA are both safe and effective techniques in the treatment of disabling SSCD. Since MFA is the more invasive technique, we suggest that TMA should be proposed as first-line treatment, temporal bone anatomy permitting. RWR outcomes are more variable in term of symptomatic control, and this option could be offered to patients at risk under general anesthesia.

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Section: Discussionsupporting

confidence: 91%

Section: Discussionmentioning

confidence: 51%

Section: Discussionmentioning

confidence: 99%

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Surgical treatments of superior semicircular canal dehiscence: A single‐centre experience in 63 cases

Nieto

Gallois

Molinier

et al. 2021

Laryngoscope Investig Oto

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“…An important aspect to consider, however, is the benefit of a middle cranial fossa (rather than transmastoid) approach to superior semicircular canal dehiscence, which is the mainstay approach for management of spontaneous CSF leak. 33 Clinicians should have a high index of suspicion for superior semicircular canal dehiscence in patients with spontaneous CSF leak when reviewing imaging, such that surgical repair could address both pathologies if required.…”

Section: Discussionmentioning

confidence: 99%

Radiological findings in spontaneous cerebrospinal fluid leaks of the temporal bone

Hendriks

Thompson²,

Boeddinghaus

et al. 2021

J. Laryngol. Otol.

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Background and objective Spontaneous cerebrospinal fluid leak of the temporal bone is an emerging clinical entity for which prompt and accurate diagnosis is difficult given the subtle signs and symptoms that patients present with. This study sought to describe the key temporal bone abnormalities in patients with spontaneous cerebrospinal fluid leak. Methods A retrospective cohort study was conducted of adult patients with biochemically confirmed spontaneous cerebrospinal fluid leak. Demographics and radiological features identified on computed tomography imaging of the temporal bones and/or magnetic resonance imaging were analysed. Results Sixty-one patients with spontaneous cerebrospinal fluid leak were identified. Fifty-four patients (88.5 per cent) underwent both temporal bone computed tomography and magnetic resonance imaging. Despite imaging revealing bilateral defects in over 75 per cent of the cohort, only two patients presented with bilateral spontaneous cerebrospinal fluid leaks. Anterior tegmen mastoideum defects were most common, with an average size of 2.5 mm (range, 1–10 mm). Conclusion Temporal bone computed tomography is sensitive for the identification of defects when suspicion exists. In the setting of an opacified middle ear and/or mastoid, close examination of the skull base is crucial given that this fluid is potentially cerebrospinal fluid.

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“…To diagnose this syndrome, physicians employ vestibular-evoked myogenic potentials (VEMPs) [ 4 , 5 ], audiometric testing, and high-resolution temporal computed tomographic (CT) scans [ 2 , 4 ]. The preferred surgical technique is via the middle cranial fossa, as it provides greater dehiscence visualization than the transmastoid approach [ 6 , 7 ]. Ehlers-Danlos syndrome hypermobility type (EDS-HT) is a subset of the aforementioned connective tissue disorder and is defined by joint hypermobility and instability [ 8 ].…”

Section: Introductionmentioning

confidence: 99%

Bilateral Superior Semicircular Canal Dehiscence Concurrent With Ehlers-Danlos Syndrome: A Case Report

Unterberger¹,

Miller²,

Gopen³

et al. 2021

Cureus

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Superior semicircular canal dehiscence (SSCD) is characterized by temporal bone thinning, which creates an opening between the inner ear and middle cranial fossa. Ehlers-Danlos syndrome, hypermobility type (EDS-HT) is a genetic collagen synthesis disorder, often resulting in bony abnormalities. We present the case of a 39-year-old female with EDS-HT who exhibited the otological symptoms characteristic of bilateral SSCD. High-resolution computed tomography (CT) scans confirmed the diagnosis. The patient elected for middle fossa craniotomy and noted symptomatic improvement. Due to its potential to confer bone fragility, EDS-HT may predispose SSCD development. Further examination of the relationship between these disorders is necessary.

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Middle cranial fossa approach for the repair of superior semicircular canal dehiscence is associated with greater symptom resolution compared to transmastoid approach

Abstract: The literature suggests that the MCF approach for the repair of SSCD is associated with greater symptom resolution when compared to the TM approach. This information could help facilitate patient discussions.

Cited by 33 publications

References 33 publications

Surgical treatments of superior semicircular canal dehiscence: A single‐centre experience in 63 cases

Surgical treatments of superior semicircular canal dehiscence: A single‐centre experience in 63 cases

Radiological findings in spontaneous cerebrospinal fluid leaks of the temporal bone

Bilateral Superior Semicircular Canal Dehiscence Concurrent With Ehlers-Danlos Syndrome: A Case Report

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