Fascia with Bone Pate Resurfacing Technique in Repairing Superior Semicircular Canal Dehiscence

Objective: To report the surgical, hearing, and balance outcomes following repair of superior semicircular canal dehiscence, implementing a novel technique utilizing fascia, bone pate, and another layer of fascia to resurface the canal dehiscence.

Setting: Tertiary Neurotologic Center.

Patients All patients who had superior semicircular canal dehiscence repaired with fascia, bone pate, and another layer of fascia through a middle fossa approach.

Methods: A retrospective review was completed evaluating all patients who underwent repair of superior semicircular canal dehiscence via a middle fossa approach with a piece of fascia placed over the dehiscence, followed by a layer of bone pate, and then another layer of fascia, between December 2012 and August 2015. Outcome measures included postoperative audiometric results, subjective resolution of clinical symptoms, and postoperative complications.

Results: Seventeen ears (15 patients, 46.7% women) underwent superior semicircular canal dehiscence repair with the described fascia-bone pate resurfacing technique. The average patient age was 45 years (range 24 – 62 years), with 64.7% of cases involving right ears. Prior repair via transmastoid approaches were performed at an outside facility in 2 patients. Preoperatively, the most frequent complaints were autophony (100%), aural fullness (N = 11, 64.7%), vertigo (N = 14, 82.4%), and Tullio’s phenomenon (N = 7, 41.2%). At a mean follow-up of 7.8 months (range 0.5 – 23, SD 6.8), 82.4% (N = 14) reported complete resolution of symptoms. Two patients endorsed persistent tinnitus, and one patient continued to experience autophony, albeit diminished. Pre- and postoperative air conduction pure-tone averages (0.5, 1, 2, and 3 kHz) were 23.8 dB HL and 26.5 dB HL, respectively, with no significant difference (p = 0.73). Pre- and postoperative word recognition scores were 94.5% and 90.3%, respectively, and were not significantly different (p = 0.40). One patient developed a surgical site infection in the setting of urosepsis in the postoperative period.

Conclusions: In superior semicircular canal dehiscence syndrome, a multi-layered resurfacing technique, consisting of fascia, bone pate, and another layer fascia, avoids the need for occluding the canal and is a safe and effective option in repairing superior semicircular canal dehiscence.