Improvements in Clinical Outcomes for Superior Semicircular Canal Dehiscence Treatment with Middle Fossa Craniotomy

Introduction: Superior semicircular canal dehiscence (SSCD) is a rare disease of the inner ear caused by a dehiscence in the tegmen of the superior semicircular canal. This defect allows atypical communication between the middle cranial fossa and the superior semicircular canal that elicits abnormal vestibular symptoms. Clinical manifestations include autophony, aural fullness, hearing loss, imbalance, dizziness, tinnitus, and headache. This study analyzes the largest series of patients for clinical outcomes of a middle fossa craniotomy approach for SSCD repair from a single institution.

Methods: Medical records of consecutive patients who underwent a middle fossa craniotomy for surgical repair of SSCD via the two senior authors at UCLA from March 2011 to August 2015 were retrospectively reviewed. Patients with bilateral SSCD and repair of both sides were evaluated for symptom resolution after the second surgery. Patient demographics, preoperative presentation, and postoperative clinical outcomes were analyzed using Fisher’s exact test with p values <0.05 considered significant.

Results: 43 patients who underwent a total of 52 surgeries were analyzed. 60.5% (26/43) of patients were female, 39.5% (17/43) were male, and mean age was 50.8 years (range: 21–84). After a mean follow-up of 7.16 months (range: 0.2–48.92), 100% (43/43) achieved at least one symptom resolution. Patients with autophony (p = 0.0001), aural fullness (p = 0.0039), hearing loss (p = 0.0147), imbalance (p = 0.0005), dizziness (p = 0.0001), and tinnitus (p = 0.0001) had significant resolution after SSCD repair via middle fossa craniotomy. Headache (p = 0.1842) was resolved in many patients but was not significant. After surgical management, 13% (3/34) of patients developed aural fullness, 5% (1/20) developed hearing loss, 29% (4/24) developed imbalance, 13% (2/15) developed dizziness, 11% (1/9) developed tinnitus, and 6% (2/31) developed headaches.

Conclusion: Significant symptom resolution can be achieved by a middle fossa craniotomy approach for surgical management of SSCD. Although this study shows promising outcomes, the disease is rare, and the available literature is scarce. Further studies with larger patient populations and longer follow-up periods are needed to fully elucidate the long-term efficacy of middle fossa craniotomy in SSCD management.