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  • SSCD Postoperative Outcomes: a Series of 156 Repairs

    Final Number:

    Prasanth Romiyo BS, BA; Courtney Duong BS; Methma Udawatta; Komal Preet BS; Isaac Yang MD

    Study Design:

    Subject Category:

    Meeting: Congress of Neurological Surgeons 2018 Annual Meeting - Late Breaking Science

    Introduction: Superior Semicircular Canal Dehiscence (SSCD) is an emerging neurosurgical subspecialty characterized by a myriad of audiological and vestibular symptoms, such as autophony, tinnitus, hearing loss, and dizziness [1-15]. Presentations are confirmed by high resolution computed tomography (CT) [1-15]. Surgical resolution has been varied for multiple symptoms, including hearing loss and dizziness [1,4-5,8-9,11]. Given the mixed results of symptom resolution of SSCD patients after surgical repair, we herein analyze the largest cohort of SSCD patients managed by a single neurosurgeon and ENT surgeon to date.

    Methods: For this study, we identified 120 patients with 156 surgical repairs for SSCD. Gender, age, surgical side, history of ear trauma, and previous ear affliction were noted. Symptoms of autophony, amplification, aural fullness, tinnitus, hyperacusis, hearing loss, vertigo, dizziness, imbalance, oscillopsia, and headaches were recorded preoperatively and postoperatively. Fischer's Exact tests, Wilcoxon-Mann-Whitney tests, and multiple variable regression were performed using SAS version 9.4.

    Results: Of 120 patients, the majority were female (n=76). Median age was 55 (± 12.7 years) and median follow up was 14 months (± 284.1). Previous ear affliction was present in 64 patients and previous trauma in 27 patients. Bilateral SSCD was present in 53 cases, with the right side (n=70) being the most repaired. Of the cohort, there were 5 surgical revisions and 11 incidents of CSF leak. There were no significant differences in gender, age, surgical side, history of ear trauma, previous ear affliction, time to follow-up, revision, or CSF leak. Preoperative symptoms were not significantly associated with any other variables. Increased postoperative dizziness and hearing loss was significantly correlated with females (p=.048, p=.041). Males significantly had better postoperative hearing (p=.044).

    Conclusions: Resolution of SSCD symptoms after surgery may be dependent on gender; however, study limitations including sample size may affect our outcomes.

    Patient Care: Understanding factors that contribute to the persistence of symptoms after surgery will help future patients with SSCD determine alternative avenues of care or, from a neurosurgical perspective, lead to improvements in operative technique.

    Learning Objectives: By the conclusion of this session, participants should be able to 1) Understand the history and clinical diagnosis of SSCD 2) Learn of the minimally invasive technologies and materials used in the repair of SSCD. 3) Understand the common complications of surgery and factors influencing refractory symptoms.

    References: 1. Beckett JS, Chung LK, Lagman C, et al. A Method of Locating the Dehiscence during Middle Fossa Approach for Superior Semicircular Canal Dehiscence Surgery. J Neurol Surg B Skull Base. Aug 2017;78(4):353-358. 2. Beckett JS, Lagman C, Chung LK, et al. Computerized Assessment of Superior Semicircular Canal Dehiscence Size using Advanced Morphological Imaging Operators. J Neurol Surg B Skull Base. Apr 2017;78(2):197-200. 3. Chung LK, Lagman C, Nagasawa DT, Gopen Q, Yang I. Superior Semicircular Canal Dehiscence in a Patient with Ehlers-Danlos Syndrome: A Case Report. Cureus. Apr 6 2017;9(4):e1141. 4. Chung LK, Ung N, Spasic M, et al. Clinical outcomes of middle fossa craniotomy for superior semicircular canal dehiscence repair. J Neurosurg. Nov 2016;125(5):1187-1193. 5. Johanis M, Yang I, Gopen Q. Incidence of intraoperative hearing loss during middle cranial fossa approach for repair of superior semicircular canal dehiscence. Journal of clinical neuroscience : official journal of the Neurosurgical Society of Australasia. Jun 13 2018. 6. Lagman C, Beckett JS, Chung LK, et al. Novel Method of Measuring Canal Dehiscence and Evaluation of its Potential as a Predictor of Symptom Outcomes After Middle Fossa Craniotomy. Neurosurgery. Aug 9 2017. 7. Lagman C, Ong V, Chung LK, et al. Pediatric superior semicircular canal dehiscence: illustrative case and systematic review. J Neurosurg Pediatr. Aug 2017;20(2):196-203. 8. Nguyen T, Lagman C, Sheppard JP, et al. Bone Metabolic Markers in the Clinical Assessment of Patients with Superior Semicircular Canal Dehiscence. World Neurosurg. Jun 2018;114:e42-e50. 9. Nguyen T, Lagman C, Sheppard JP, et al. Middle cranial fossa approach for the repair of superior semicircular canal dehiscence is associated with greater symptom resolution compared to transmastoid approach. Acta Neurochir (Wien). Jun 2018;160(6):1219-1224. 10. Peng KA, Ahmed S, Yang I, Gopen Q. Temporal bone fracture causing superior semicircular canal dehiscence. Case Rep Otolaryngol. 2014;2014:817291. 11. Spasic M, Trang A, Chung LK, et al. Clinical Characteristics of Posterior and Lateral Semicircular Canal Dehiscence. J Neurol Surg B Skull Base. Dec 2015;76(6):421-425. 12. Trieu V, Pelargos PE, Spasic M, et al. Minimally Invasive Middle Fossa Keyhole Craniectomy for Repair of Superior Semicircular Canal Dehiscence. Oper Neurosurg (Hagerstown). Jun 1 2017;13(3):317-323. 13. Ung N, Chung LK, Lagman C, et al. Outcomes of middle fossa craniotomy for the repair of superior semicircular canal dehiscence. Journal of clinical neuroscience : official journal of the Neurosurgical Society of Australasia. Sep 2017;43:103-107. 14. Yew A, Zarinkhou G, Spasic M, Trang A, Gopen Q, Yang I. Characteristics and management of superior semicircular canal dehiscence. J Neurol Surg B Skull Base. Dec 2012;73(6):365-370. 15. Xie Y, Sharon JD, Pross SE, et al. Surgical Complications from Superior Canal Dehiscence Syndrome Repair: Two Decades of Experience. Otolaryngol Head Neck Surg. Aug 2017;157(2):273-280.

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