Superior Semicircular Canal Dehiscence Repair through Middle Cranial Fossa Craniotomy with 5 Layers Reconstruction: Our Experience and Surgical Technique

Introduction: Superior semicircular canal dehiscence (SSCD) is a rare condition that has been recently described. SSCD symptoms include vertigo, oscillopsia, autophony, hypersensitivity to bone conducted sounds, and an apparent conductive hearing loss. Patients who present with severe symptoms may require surgical treatment. Transmastoid and middle fossa approaches are the most common surgical approaches.

Methods: We are presenting our experience at the Ottawa Hospital (TOH) and University of Ottawa over the last three years in patients who underwent middle cranial fossa craniotomy with multi-layer (5 layers) reconstruction. Also we describe our multidisciplinary surgical approach and modalities which we use to help localize the SSCD intraoperatively. Patients’ demographic data, presenting symptoms, co-morbidities, radiologic imaging, and length of surgery were recorded. All patients had hearing and vestibular tests before surgery and within 3 months after their surgery.

Results: Over the past 3 years, 14 surgeries were performed in 11 patients (three patients had bilateral SSCD). The majority of our patients were males (82%). The age range was 32 to 68 years. All surgeries were done by a team of a neurosurgeon and a neuro-otologist. Localization of the SSCD was done with the help of stereotactic guidance. Five layers’ reconstruction (bone graft, bone dust, artificial dura, temporalis fascia & fibrin sealant) was performed on all of our patients. All patients had significant improvement in their symptoms without sensorineural hearing loss. None of our patients developed post-operative hematoma, infection, seizures, cerebrospinal fluid leakage or facial palsy. Patients left the hospital within 1–2 days.

Conclusion: Middle cranial fossa craniotomy with multi layers reconstruction of SSCD should be considered as a safe and effective surgical approach in severely symptomatic patients. We demonstrated that this approach has minimal risks especially in regards to sensorineural hearing loss.