Efficacy assessment and complications of surgical management for superior semicircular canal dehiscence: a meta-analysis of published interventional studies

Abstract

Superior semicircular canal syndrome (SSCS) includes vestibular and audiological symptoms which result from the introduction of a third mobile window into the osseous cochlea. Surgical repair is considered in cases of incapacitating symptoms. The present paper aims at comparing the different surgical approaches and modes of dehiscence repair, regarding their respective efficacy and potential pitfalls. A systematic literature review and meta-analysis of pooled data were performed. Study selection included prospective- and retrospective-controlled studies, prospective- and retrospective-cohort studies, ex vivo studies, animal models, case-reports, systematic reviews and clinical guidelines. A total of 64 primary operations for SSC repair were identified; 56 ears were operated for vestibular and 7 for auditory complaints. A total of 33 ears underwent canal plugging, 16 resurfacing, and 15 capping. Success rates were 32/33, 8/16, and 14/15, respectively. The observed differences were statistically significant (P=0.001). Resurfacing proved less effective than both plugging (P=0.002), and capping (P=0.01) techniques. Temporalis fascia was commonly used as sealing material and was combined with bone-pâté/bone-wax (plugging), bone-graft (resurfacing), or hydroxyapatite-cement (capping). Most operations were performed via middle-fossa approach; higher success rates were associated with plugging and capping techniques. SNHL and disequilibrium were the most frequent complications encountered. Most cases were followed for 3-6 months. Precise criteria regarding follow-up duration and objective success measures are not determined. Surgical repair of SSCS is considered as a valid therapeutic option for patients with debilitating symptoms. Consensus regarding strict follow-up criteria and objective assessment of success is necessary before larger scale operations can be implemented in clinical practice.

A case report of two different skull base pathologies causing hearing loss in the same ear: vestibular schwannoma and superior semicircular canal dehiscence

“…The presence of stapedius reflex with lowfrequency conductive hearing loss should prompt radiological imaging of the inner ear to exclude the possibility of dehiscence of the inner ear [7]. Patients with debilitating symptoms may require surgical repair via an open or endoscopic middle cranial fossa approach during which the dehiscent area of the canal may be repaired with canal plugging, capping, or resurfacing procedures [2]. Round window tissue reinforcement and plugging of the superior semicircular canal via a transmastoid approach are alternate approaches for SSCD repair [8,9].…”

“…Semicircular canal dehiscence causes an abnormal communication between the inner ear and the surrounding structures. The most common is the SSCD, which may lead to a syndrome of vertigo and oscillopsia, being referred to as SSCD syndrome [2]. Patients complain of vertigo when exposed to loud noises (Tullio phenomenon), Valsalva maneuvers, pressure changes in the ear (Hennebert sign), or with factors that raise intracranial pressures.…”

“…Vestibular schwannoma (VS) is the most common tumor that causes sensorineural hearing loss [1]. Superior canal dehiscence (SSCD) has also been described to cause decrease in hearing by dissemination of the acoustic energy through a mobile third window created by the dehiscence [2]. We describe a case report of a patient that presented with symptoms of hearing loss and dizziness and was found to have both of these rare pathologies in the same ear.…”

Trans-mastoid Repair of Superior Semicircular Canal Dehiscence

“…While resurfacing of the Sup SC does require an extradural middle cranial fossa approach, plugging of the canal can be achieved via a transmastoid approach avoiding the need for a craniotomy and temporal lobe retraction. [4][5][6] In view of this, our practice has changed Keywords ► transmastoid ► plugging ► superior semicircular canal dehiscence…”

“…However, in a recent meta-analysis, it was found that resurfacing had higher failure and recurrence rates compared with canal plugging. 6 A middle cranial fossa approach is also associated with the morbidity of a craniotomy and temporal lobe retraction. Some authors have also argued that traumatic manipulation or inadvertent suctioning of the membranous labyrinthine and loss of perilymph during dural elevation may contribute toward postoperative sensorineural hearing loss 5 which has been reported in case series to be as high as 30%.…”