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Valika T, Redleaf M. Middle Cranial Fossa Dehiscence as an Incidental Finding on CT. Ann Otol Rhinol Laryngol 2016; 125:729-33. [PMID: 27242365 DOI: 10.1177/0003489416650683] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
OBJECTIVES This retrospective chart review demonstrates that the prevalence of middle cranial fossa (MCF) dehiscence on computed tomography (CT) scans increases with age. METHODS High-resolution temporal bone CT scans, which had been obtained for any otologic complaint, were reviewed independent of all clinical history. Scans showing soft tissue, fluid, trauma, or previous operations were excluded. The CTs from 183 patients (296 ears) were reviewed, blinded for age and body mass index (BMI). The MCF floor was divided into 7 regions and systematically inspected. Ages and BMIs of the patients were subsequently extracted from the medical record. RESULTS Logistic regression analysis confirmed increasing MCF dehiscence with age (P < .05, odds ratio [OR] = 1.07, R = .584). Over all ages (range, 1-88 years; average, 38.5), 32% of MCF floors were dehiscent at any 1 site. For age 60 and over, 55% were dehiscent. The most common sites of MCF dehisence were directly above the malleus head and above the additus ad antrum (35% and 28%, respectively). Superior canal dehiscence (SCD) was seen in 7% of all patients and only in the context of MCF dehiscence. The prevalence of MCF dehiscence increased with age when patients were analyzed by BMI <25, BMI = 25-30, and BMI >30 (P < .003, P < .04, P = .03). CONCLUSION The increase of middle cranial fossa dehiscence with respect to age is statistically significant. Over all ages, approximately 32% of ears show dehiscence. Over 60 years, approximately 55% show dehiscence. The odds of having dehiscence double with a 10-year difference in age. The most common sites along the MCF floor are in the epitympanum over the malleus head and the additus ad antrum. There was a statistically significant increase in MCF dehiscence with age when patients with equivalent BMIs are compared.
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Affiliation(s)
- Taher Valika
- Department of Otolaryngology-Head & Neck Surgery, University of Illinois at Chicago, Illinois, USA
| | - Miriam Redleaf
- Department of Otolaryngology-Head & Neck Surgery, University of Illinois at Chicago, Illinois, USA
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Klopp-Dutote N, Kolski C, Biet A, Strunski V, Page C. A radiologic and anatomic study of the superior semicircular canal. Eur Ann Otorhinolaryngol Head Neck Dis 2015; 133:91-4. [PMID: 26671715 DOI: 10.1016/j.anorl.2015.11.001] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
OBJECTIVES The present study sought to determine whether there is a correlation between the prevalence of superior semicircular canal (SSC) dehiscence (SSCD) on temporal CT and population age. The secondary objective was to identify anatomic factors for SSCD by studying SSC diameter and its protrusion into the middle cranial fossa. The aim was to determine the acquired or congenital origin of SSCD (Minor's syndrome). MATERIAL AND METHOD A single-center retrospective radiological and anatomic study included 180 CT scans of 354 petrous parts of the temporal bone taken between January and December 2011 in a university hospital center. Bone thickness above the SSC was measured and classified in 4 grades: grade 1, >2.5mm; grade 2, <2.5mm: grade 3, predehiscent; grade 4, dehiscent. SSC diameter was also measured, as was the height of SSC protrusion into the middle cranial fossa. RESULTS SSCD was found in 0.8% of cases and predehiscence in 12%. Patients with dehiscence were older; patients with grade 3 or 4 were significantly older than those free of dehiscence (P<0.05). There was no significant difference in SSC diameter according to grade. In grade 1, protrusion was greater than in other subjects, with a significant correlation between age and reduced protrusion (P<0.05). CONCLUSION The study demonstrated a correlation between aging and SSCD prevalence. Reduced SSC roof height with age suggests that SSCD may be an acquired phenomenon, related in some way to aging of the base of the skull.
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Affiliation(s)
- N Klopp-Dutote
- Service d'ORL et de chirurgie de la face et du cou, hôpital Nord, CHU, place Victor-Pauchet, 80054 Amiens cedex, France
| | - C Kolski
- Service d'ORL et de chirurgie de la face et du cou, hôpital Nord, CHU, place Victor-Pauchet, 80054 Amiens cedex, France
| | - A Biet
- Service d'ORL et de chirurgie de la face et du cou, hôpital Nord, CHU, place Victor-Pauchet, 80054 Amiens cedex, France
| | - V Strunski
- Service d'ORL et de chirurgie de la face et du cou, hôpital Nord, CHU, place Victor-Pauchet, 80054 Amiens cedex, France
| | - C Page
- Service d'ORL et de chirurgie de la face et du cou, hôpital Nord, CHU, place Victor-Pauchet, 80054 Amiens cedex, France.
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Abstract
OBJECTIVE Surgical access to repair a superior canal dehiscence (SCD) is influenced by the location of the bony defect and its relationship to surrounding tegmen topography as seen on computed tomography. There are currently no agreed-upon methods of characterizing these radiologic findings. We propose a formal radiologic classification system of SCD based on dehiscence location and adjacent tegmen topography. STUDY DESIGN Retrospective case review SETTING Tertiary, neurotology referral center PATIENTS We identified 298 patients with superior canal dehiscence on CT from February 2001 to October 2013. Of these, 251 had symptomatic superior canal dehiscence syndrome and were included in the study. INTERVENTION Patients underwent high-resolution temporal bone CT scans with creation of axial, coronal, Pöschl, and Stenver reformatted images to examine the superior semicircular canal. Two residents-in-training and a head and neck radiologist independently read the scans. MAIN OUTCOME MEASURES CT scans were assessed for (1) superior canal dehiscence or "near" dehiscence, (2) defect location relative to the skull base, (3) surrounding tegmen defects, (4) geniculate ganglion dehiscence, (5) superior petrosal sinus-associated dehiscence (SPS), (6) low-lying tegmen, and (7) the distance between the outer table of the temporal bone and the arcuate eminence.
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Dilemmas in the Treatment of Concurrent Bilateral Meningoencephalocele and Superior Semicircular Canal Dehiscence. Otol Neurotol 2015; 36:932-5. [DOI: 10.1097/mao.0000000000000729] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
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Davey S, Kelly-Morland C, Phillips JS, Nunney I, Pawaroo D. Assessment of superior semicircular canal thickness with advancing age. Laryngoscope 2015; 125:1940-5. [PMID: 25779775 DOI: 10.1002/lary.25243] [Citation(s) in RCA: 29] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/09/2015] [Indexed: 11/10/2022]
Abstract
OBJECTIVE To determine whether superior semicircular canal dehiscence (SSCD) is more prevalent with advancing age. STUDY DESIGN Retrospective observational study. METHODS High-resolution computed-tomographic temporal bone scans were identified for patients of all ages and analyzed by two independent assessors. Multiplanar reconstruction was applied, and the thinnest area of temporal bone overlying each superior semicircular canal (SSC) was measured. RESULTS A sample of 121 patients was analyzed that contained an almost identical number of male and female patients. In total, 242 temporal bone images were reviewed. Patients' ages ranged between 6 and 86 years. Age was shown to have a significant linear relationship (P < 0.001) such that for every unit increase in age the predicted thickness was reduced by 0.0047 mm. CONCLUSIONS The thickness of the SSC decreases with advancing age. LEVEL OF EVIDENCE 4.
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Affiliation(s)
- Shaun Davey
- Departments of Otolaryngology and Radiology, Norfolk and Norwich University Hospitals NHS Foundation Trust (S.D., C.K-M., J.S.P., D.P.)
| | - Christian Kelly-Morland
- Departments of Otolaryngology and Radiology, Norfolk and Norwich University Hospitals NHS Foundation Trust (S.D., C.K-M., J.S.P., D.P.)
| | - John S Phillips
- Departments of Otolaryngology and Radiology, Norfolk and Norwich University Hospitals NHS Foundation Trust (S.D., C.K-M., J.S.P., D.P.)
| | - Ian Nunney
- Norwich Clinical Trials Unit, Norwich Medical School, University of East Anglia, Norwich, United Kingdom
| | - Davina Pawaroo
- Departments of Otolaryngology and Radiology, Norfolk and Norwich University Hospitals NHS Foundation Trust (S.D., C.K-M., J.S.P., D.P.)
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Saxby AJ, Gowdy C, Fandiño M, Chadha NK, Kozak FK, Sargent MA, Lea J. Radiological prevalence of superior and posterior semicircular canal dehiscence in children. Int J Pediatr Otorhinolaryngol 2015; 79:411-8. [PMID: 25636666 DOI: 10.1016/j.ijporl.2015.01.001] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/30/2014] [Revised: 12/28/2014] [Accepted: 01/01/2015] [Indexed: 10/24/2022]
Abstract
OBJECTIVE Establishing the prevalence of semicircular canal dehiscence in a pediatric population using temporal bone CT imaging. STUDY DESIGN Retrospective analysis of all temporal bone CT scans during a 5-year period (2007-2012). METHODS CT scan images were reformatted in the plane of the canals and assessed by two independent reviewers with a third to resolve disagreement. Detailed chart review was performed for those found to have dehiscence. Superior and posterior canals were classified as "dehiscent", "possibly dehiscent", "thin" or "normal" for each case. RESULTS 649 temporal bones were assessed from 334 children (under 18 years of age). The prevalence rate of superior canal dehiscence (SCD) was 1.7% (3.3% of individuals). Posterior canal dehiscence (PCD) was present in 1.2% (2.1% of individuals). There were no cases of bilateral SCD, and one case of bilateral PCD. Age under 3 years was associated with a higher prevalence of thinning but not dehiscence. Congenital inner ear malformation was not related to a higher probability of dehiscence. The superior petrosal sinus was associated with the SCD in three cases (27.3%). Retrospective chart review highlighted possible vestibular symptoms in 3/11 patients with SCD (27.3%). CONCLUSIONS This forms the largest pediatric study of canal dehiscence to date. This study's prevalence rate is significantly lower than previous reports. The identified association with overlying venous structures may reflect the etiological process involved. The occurrence in children supports the hypothesis of a congenital predisposition for development of canal dehiscence syndrome.
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Affiliation(s)
- Alexander J Saxby
- Division of Pediatric Otolaryngology, Head and Neck Surgery, BC Children's Hospital, 4480 Oak Street, Vancouver, BC V6H 3N1, Canada.
| | - Claire Gowdy
- Department of Radiology, BC Children's Hospital, 4480 Oak Street, Vancouver, BC V6H 3N1, Canada.
| | - Marcela Fandiño
- Division of Pediatric Otolaryngology, Head and Neck Surgery, BC Children's Hospital, 4480 Oak Street, Vancouver, BC V6H 3N1, Canada.
| | - Neil K Chadha
- Division of Pediatric Otolaryngology, Head and Neck Surgery, BC Children's Hospital, 4480 Oak Street, Vancouver, BC V6H 3N1, Canada.
| | - Frederick K Kozak
- Division of Pediatric Otolaryngology, Head and Neck Surgery, BC Children's Hospital, 4480 Oak Street, Vancouver, BC V6H 3N1, Canada.
| | - Michael A Sargent
- Department of Radiology, BC Children's Hospital, 4480 Oak Street, Vancouver, BC V6H 3N1, Canada.
| | - Jane Lea
- Division of Pediatric Otolaryngology, Head and Neck Surgery, BC Children's Hospital, 4480 Oak Street, Vancouver, BC V6H 3N1, Canada.
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The Correlation Between Obesity, Obstructive Sleep Apnea, and Superior Semicircular Canal Dehiscence. Otol Neurotol 2015; 36:551-4. [DOI: 10.1097/mao.0000000000000555] [Citation(s) in RCA: 40] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Recent advances in superior semicircular canal dehiscence syndrome. The Journal of Laryngology & Otology 2015; 129:217-25. [DOI: 10.1017/s0022215115000183] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
AbstractObjective:This study aimed to review the current advances in superior semicircular canal dehiscence syndrome and to ascertain its aetiology, whether dehiscence size correlates with symptoms, signs and investigation results, the best investigations, and its surgical management.Methods:A literature search using the key words ‘superior semicircular canal dehiscence’ was performed using the Allied and Complementary Medicine Database and the Embase, Health Management Information Consortium, Medline, PsycINFO, British Nursing Index, Cinahl and Health Business Elite databases for the period January 2009 to May 2014. Systematic reviews, meta-analyses, randomised controlled trials, prospective and retrospective case series, case reports, and observational studies were included.Results:Of the 205 papers identified, 35 were considered relevant.Conclusion:The aetiology of superior semicircular canal dehiscence syndrome is unclear. Dehiscence size significantly affects the air–bone gap and ocular vestibular evoked myogenic potential thresholds. Computed tomography evaluation has a high false positive rate. The middle cranial fossa approach is the surgical standard for treating this syndrome; however, the transmastoid approach is gaining popularity.
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Stevens SM, Lambert PR, Rizk H, McIlwain WR, Nguyen SA, Meyer TA. Novel radiographic measurement algorithm demonstrating a link between obesity and lateral skull base attenuation. Otolaryngol Head Neck Surg 2014; 152:172-9. [PMID: 25450407 DOI: 10.1177/0194599814557470] [Citation(s) in RCA: 38] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
OBJECTIVES (1) To describe a validated algorithm for measuring tegmen thickness on computed tomography scans. (2) To compare the tegmen thickness in 3 groups: patients with spontaneous cerebrospinal fluid (CSF) leaks, obese controls, and nonobese controls. STUDY DESIGN Retrospective review. SETTING Patients with spontaneous CSF otorrhea often have highly attenuated tegmen plates. This is associated with obesity and/or idiopathic intracranial hypertension (IIH). No evidence exists, however, that objectively links obesity and/or IIH with skull base attenuation. SUBJECTS AND METHODS This was a retrospective review from 2004 to the present. Patients with spontaneous CSF otorrhea and matched obese (body mass index [BMI] >30 kg/m(2)) and nonobese (BMI <30 kg/m(2)) controls were selected. Tegmen thickness was measured radiographically. Interrater validity was assessed. RESULTS Ninety-eight patients were measured: 37 in the CSF group (BMI, 36.6 kg/m(2)), 30 in the obese group (BMI, 34.6 kg/m(2)), and 31 in the nonobese group (BMI, 24.2 kg/m(2)). The CSF group had a significantly thinner tegmen compared to both the obese control (P < .01) and nonobese control (P = .0004) groups. Obese controls had a thinner tegmen than nonobese controls (P < .00001). A significant inverse correlation was detected between skull base thickness and BMI. Signs/symptoms of IIH were most commonly found in the CSF group. Good to very good strength of agreement was detected for measures between raters. CONCLUSION This is the first study to (1) quantify lateral skull base thickness and (2) significantly correlate obesity with lateral skull base attenuation. Patients who are obese with spontaneous CSF leaks have greater attenuation of their skull base than matched obese controls. This finding supports theories that an additional process, possibly congenital, has a pathoetiological role in skull base dehiscence.
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Affiliation(s)
- Shawn M Stevens
- Department of Otolaryngology-Head and Neck Surgery, Medical University of South Carolina, Charleston, South Carolina, USA
| | - Paul R Lambert
- Department of Otolaryngology-Head and Neck Surgery, Medical University of South Carolina, Charleston, South Carolina, USA
| | - Habib Rizk
- Department of Otolaryngology-Head and Neck Surgery, Medical University of South Carolina, Charleston, South Carolina, USA
| | - Wesley R McIlwain
- Department of Otolaryngology-Head and Neck Surgery, Madigan Army Medical Center, Tacoma, Washington, USA
| | - Shaun A Nguyen
- Department of Otolaryngology-Head and Neck Surgery, Medical University of South Carolina, Charleston, South Carolina, USA
| | - Ted A Meyer
- Department of Otolaryngology-Head and Neck Surgery, Medical University of South Carolina, Charleston, South Carolina, USA
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Sepúlveda I, Schmidt T, Platín E. Use of cone beam computed tomography in the diagnosis of superior semicircular canal dehiscence. J Clin Imaging Sci 2014; 4:49. [PMID: 25337435 PMCID: PMC4204297 DOI: 10.4103/2156-7514.141554] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/22/2014] [Accepted: 08/19/2014] [Indexed: 11/04/2022] Open
Abstract
Superior semicircular canal dehiscence is a relatively new syndrome in the field of otology. It is of unknown etiology presenting with a variety of vestibular and auditory symptoms and radiologic findings play a crucial role in its diagnosis. Cone beam computed tomography has been shown to be a powerful tool in the field of otolaryngology. It is a three dimensional technique that uses lower radiation resulting in fewer artifacts and offers higher resolution when compared with multi-slice computed tomography. It is considered to be an excellent imaging modality for radiological exploration of the ear.
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Affiliation(s)
- Ilson Sepúlveda
- Department of Oral and Maxillofacial Radiology, Otolaryngology Head and Neck Surgery Service General Hospital of Concepcion, Cone Beam Concepcion, Advanced Craniofacial Imaging Center, Finis Terrae University School of Dentistry, Santiago, Chile
| | - Thomas Schmidt
- Department of Physician Otolaryngologist, Otolaryngology Head and Neck Surgery Service, General Hospital of Concepcion. University of Concepción School of Medicine, Concepción, Chile
| | - Enrique Platín
- Department of Oral and Maxillofacial Radiology, University of North Carolina School of Dentistry, Chapel Hill, North Carolina, USA
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Radiographic features of superior semicircular canal dehiscence in the setting of chronic ear disease. Otol Neurotol 2014; 35:91-6. [PMID: 24136312 DOI: 10.1097/mao.0b013e3182a03522] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/02/2023]
Abstract
OBJECTIVE To determine if radiologic chronic otitis media (COM), both with and without cholesteatoma, is associated with superior semicircular canal dehiscence (SSCD). STUDY DESIGN Retrospective review of consecutive high-resolution computed tomography (HRCT) scans of the temporal bone. SETTING Tertiary care medical center. PATIENTS Two hundred consecutive patients undergoing HRCT of the temporal bone beginning January 1, 2012. INTERVENTION Imaging was evaluated by 3 reviewers (2 neuroradiologists and 1 neurotologist). All scans were assessed for the presence of SSCD, cholesteatoma, chronic otomastoiditis, tegmen dehiscence, and for abnormalities of the cochlea, vestibule, facial nerve, and temporal bone vasculature. MAIN OUTCOME MEASURE Ears with COM associated with chronic otomastoiditis or cholesteatoma were compared with those without COM with respect to the presence of SSCD or other temporal bone abnormalities. Statistical analysis was performed to assess for differences between the groups studied. RESULTS One-hundred ninety-four patients (388 ears) were included. Cholesteatoma was identified in 48 ears (12.4%) and chronic otomastoiditis in 62 ears (16%). Ten ears with cholesteatoma had ipsilateral SSCD, and 8 ears with chronic otomastoiditis had ipsilateral SSCD. In 340 ears without either cholesteatoma or chronic otomastoiditis, SSCD was found in 18 (5.3%). SSCD was found to occur significantly more often in patients with ipsilateral radiologic cholesteatoma. No cases of SSCD were associated with cochlear, facial nerve, or vascular abnormalities. CONCLUSION Our findings suggest that COM with cholesteatoma is associated with the presence of SSCD, although the nature of this association is unclear.
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Evaluation of the superior semicircular canal morphology using cone beam computed tomography: a possible correlation for temporomandibular joint symptoms. Oral Surg Oral Med Oral Pathol Oral Radiol 2014; 117:e280-8. [DOI: 10.1016/j.oooo.2014.01.011] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/27/2013] [Revised: 12/20/2013] [Accepted: 01/05/2014] [Indexed: 11/18/2022]
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The Prevalence of Superior Semicircular Canal Dehiscence in Conductive and Mixed Hearing Loss in the Absence of Other Pathology Using Submillimetric Temporal Bone Computed Tomography. J Comput Assist Tomogr 2014; 38:190-5. [DOI: 10.1097/rct.0b013e3182ab2afb] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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Bradshaw AP, Taubman DS, Todd MJ, Magnussen JS, Halmagyi GM. Augmented active surface model for the recovery of small structures in CT. IEEE TRANSACTIONS ON IMAGE PROCESSING : A PUBLICATION OF THE IEEE SIGNAL PROCESSING SOCIETY 2013; 22:4394-4406. [PMID: 24048014 DOI: 10.1109/tip.2013.2273666] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/02/2023]
Abstract
This paper devises an augmented active surface model for the recovery of small structures in a low resolution and high noise setting, where the role of regularization is especially important. The emphasis here is on evaluating performance using real clinical computed tomography (CT) data with comparisons made to an objective ground truth acquired using micro-CT. In this paper, we show that the application of conventional active contour methods to small objects leads to non-optimal results because of the inherent properties of the energy terms and their interactions with one another. We show that the blind use of a gradient magnitude based energy performs poorly at these object scales and that the point spread function (PSF) is a critical factor that needs to be accounted for. We propose a new model that augments the external energy with prior knowledge by incorporating the PSF and the assumption of reasonably constant underlying CT numbers.
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Radiological patterns of the posterior semicircular canal. Surg Radiol Anat 2013; 36:137-40. [DOI: 10.1007/s00276-013-1155-8] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/27/2013] [Accepted: 06/11/2013] [Indexed: 10/26/2022]
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Browaeys P, Larson TL, Wong ML, Patel U. Can MRI replace CT in evaluating semicircular canal dehiscence? AJNR Am J Neuroradiol 2013; 34:1421-7. [PMID: 23518357 DOI: 10.3174/ajnr.a3459] [Citation(s) in RCA: 34] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
Abstract
BACKGROUND AND PURPOSE Patients with symptoms of semicircular canal dehiscence often undergo both CT and MR imaging. We assessed whether FIESTA can replace temporal bone CT in evaluating patients for SC dehiscence. MATERIALS AND METHODS We retrospectively reviewed 112 consecutive patients (224 ears) with vestibulocochlear symptoms who underwent concurrent MR imaging and CT of the temporal bones between 2007 and 2009. MR imaging protocol included a FIESTA sequence covering the temporal bone (axial 0.8-mm section thickness, 0.4-mm spacing, coronal/oblique reformations; 41 patients at 1.5T, 71 patients at 3T). CT was performed on a 64-row multidetector row scanner (0.625-mm axial acquisition, with coronal/oblique reformations). Both ears of each patient were evaluated for dehiscence of the superior and posterior semicircular canals in consensual fashion by 2 neuroradiologists. Analysis of the FIESTA sequence and reformations was performed first for the MR imaging evaluation. CT evaluation was performed at least 2 weeks after the MR imaging review, resulting in a blinded comparison of CT with MR imaging. CT was used as the reference standard to evaluate the MR imaging results. RESULTS For SSC dehiscence, MR imaging sensitivity was 100%, specificity was 96.5%, positive predictive value was 61.1%, and negative predictive value was 100% in comparison with CT. For PSC dehiscence, MR imaging sensitivity was 100%, specificity was 99.1%, positive predictive value was 33.3%, and negative predictive value was 100% in comparison with CT. CONCLUSIONS MR imaging, with a sensitivity and negative predictive value of 100%, conclusively excludes SSC or PSC dehiscence. Negative findings on MR imaging preclude the need for CT to detect SC dehiscence. Only patients with positive findings on MR imaging should undergo CT evaluation.
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Affiliation(s)
- P Browaeys
- Department of Radiology, University Hospital, Lausanne, Switzerland.
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Gracia-Tello B, Cisneros A, Crovetto R, Martinez C, Rodriguez O, Lecumberri I, Crovetto MÁ, Whyte J. Influencia de la existencia de una dehiscencia en un canal semicircular en el espesor óseo de los canales contralaterales. ACTA OTORRINOLARINGOLOGICA ESPANOLA 2013; 64:97-101. [DOI: 10.1016/j.otorri.2012.10.004] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/13/2012] [Revised: 09/19/2012] [Accepted: 10/10/2012] [Indexed: 10/27/2022]
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Gracia-Tello B, Cisneros A, Crovetto R, Martinez C, Rodriguez O, Lecumberri I, Crovetto MÁ, Whyte J. Effect of Semicircular Canal Dehiscence on Contralateral Canal Bone Thickness. ACTA ACUST UNITED AC 2013. [DOI: 10.1016/j.otoeng.2013.04.004] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
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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 2012; 73:365-70. [PMID: 24294552 PMCID: PMC3578588 DOI: 10.1055/s-0032-1324397] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/03/2012] [Accepted: 06/08/2012] [Indexed: 02/06/2023] Open
Abstract
Objectives To review the characteristic symptoms of superior semicircular canal dehiscence, testing and imaging of the disease, and the current treatment and surgical options. Results and Conclusions Symptoms of superior semicircular canal dehiscence (SSCD) include autophony, inner ear conductive hearing loss, Hennebert sign, and sound-induced episodic vertigo and disequilibrium (Tullio phenomenon), among others. Potential etiologies noted for canal dehiscence include possible developmental abnormalities, congenital defects, chronic otitis media with cholesteatoma, fibrous dysplasia, and high-riding jugular bulb. Computed tomography (CT), vestibular evoked myogenic potentials, Valsalva maneuvers, and certain auditory testing may prove useful in the detection and evaluation of dehiscence syndrome. Multislice temporal bone CT examinations are normally performed with fine-cut (0.5- to 0.6-mm) collimation reformatted to the plane of the superior canal such that images are parallel and orthogonal to the plane. For the successful alleviation of auditory and vestibular symptoms, a bony dehiscence can be surgically resurfaced, plugged, or capped through a middle fossa craniotomy or the transmastoid approach. SSCD should only be surgically treated in patients who exhibit clinical manifestations.
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Affiliation(s)
- Andrew Yew
- Department of Neurosurgery, University of California Los Angeles, Los Angeles, California, United States
| | - Golmah Zarinkhou
- Department of Neurosurgery, University of California Los Angeles, Los Angeles, California, United States
| | - Marko Spasic
- Department of Neurosurgery, University of California Los Angeles, Los Angeles, California, United States
| | - Andy Trang
- Department of Neurosurgery, University of California Los Angeles, Los Angeles, California, United States
| | - Quinton Gopen
- Department of Head and Neck Surgery, University of California Los Angeles, Los Angeles, California, United States
| | - Isaac Yang
- Department of Neurosurgery, University of California Los Angeles, Los Angeles, California, United States
- Jonsson Comprehensive Cancer Center, University of California Los Angeles, Los Angeles, California, United States
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Influence of aging and menopause in the origin of the superior semicircular canal dehiscence. Otol Neurotol 2012; 33:681-4. [PMID: 22569143 DOI: 10.1097/mao.0b013e31824f9969] [Citation(s) in RCA: 33] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
OBJECTIVE Determine if aging and menopause, known to be associated with bone resortion, also are associated with superior semicircular canal dehiscence. DESIGN Observational study. SETTING Study conducted in 3 tertiary Spanish hospitals. PATIENTS Nonselected consecutive patients of all ages. INTERVENTIONS Thin-section multi-detector row computed tomographic scan of the temporal bones. MAIN OUTCOME MEASURE The minimum thickness of the bone covering the roof of the superior semicircular canal (SSC) measured in each temporal bone. The outcome was studied both as a continuous and as a dichotomous variable: thin (<0.6 mm) and normal (≥ 0.6 mm). RESULTS Five hundred eighty-two ears of 312 patients were included in the study. Fifty-five percent of the sample were women. Patient's age ranged from 2 to 88 years. A 40-year age difference between ears was associated with a decreased thickness of bone covering the SSC of 0.10 mm, which is 10% of the average thickness of such bone. The thickness of the bone overlying the SSC of subjects younger than 45 years was an average of 1.14 mm (SD, 0.52 mm), whereas that of the subjects older than 45 years was equal to 1.02 mm (SD, 0.45 mm; p = 0.006). The percentage of ears with thin bone coverage of SSC was 7.1% in subjects younger than 45 years and 13.8% in those older than 45 years (p = 0.013). CONCLUSION Our data support the hypothesis that there is a slight osteopenia of the roof of the superior semicircular canal associated with aging, and this effect seems to be more pronounced in menopausal women.
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Abstract
OBJECTIVES To describe the clinical and radiologic features of associated spontaneous tegmen defects (STDs) with semicircular canal dehiscences (SCCDs) and to postulate a novel etiopathogenic hypothesis of these pathologic conditions. METHODS Medical records of all patients with surgically confirmed STD between 2001 and May 2010 were reviewed. We excluded all secondary tegmen defects. Clinical, audiological, and radiologic data were analyzed. RESULTS Twenty-three patients matched the inclusion criteria. Semicircular canal dehiscence was associated to STD in 13 patients. Of these patients, 12 (95%) had protruding superior semicircular canals in the middle cranial fossa versus only 3 (30%) of 10 patients for the nondehiscent cases. Twenty-two patients complained of hearing loss. Cerebrospinal fluid leak was found in 13 patients. Four patients had history of meningitis. Vestibular symptoms were present in 8 patients. CONCLUSION This is the largest series of reported coexistence of STD and SCCD in the literature. Protrusion of the superior semicircular canal in the middle cranial fossa is probably an additional factor underlying STD and SCCD etiopathogeny. Semicircular canal dehiscence should always be looked for when STD is present.
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Yu A, Teich DL, Moonis G, Wong ET. Superior semicircular canal dehiscence in East Asian women with osteoporosis. BMC EAR, NOSE, AND THROAT DISORDERS 2012; 12:8. [PMID: 22831544 PMCID: PMC3503862 DOI: 10.1186/1472-6815-12-8] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 01/01/2012] [Accepted: 07/12/2012] [Indexed: 11/18/2022]
Abstract
UNLABELLED BACKGROUND Superior semicircular canal dehiscence (SSCD) may cause Tullio phenomenon (sound-induced vertigo) or Hennebert sign (valsalva-induced vertigo) due to the absence of bone overlying the SSC. We document a case series of elderly East Asian women with atypical SSCD symptoms, radiologically confirmed dehiscence and concurrent osteoporosis. METHODS A retrospective record review was performed on patients with dizziness, vertigo, and/or imbalance from a neurology clinic in a community health center serving the East Asian population in Boston. SSCD was confirmed by multi-detector, high-resolution CT of the temporal bone (with Pöschl and Stenvers reformations) and osteoporosis was documented by bone mineral density (BMD) scans. RESULTS Of the 496 patients seen in the neurology clinic of a community health center from 2008 to 2010, 76 (17.3%) had symptoms of dizziness, vertigo, and/or imbalance. Five (6.6%) had confirmed SSCD by multi-detector, high-resolution CT of the temporal bone with longitudinal areas of dehiscence along the long axis of SSC, ranging from 0.4 to 3.0 mm, as seen on the Pöschl view. Two of the 5 patients experienced motion-induced vertigo, two fell due to disequilibrium, and one had chronic dizziness. None had a history of head trauma, otologic surgery, or active intracerebral disease. On neurological examination, two patients had inducible vertigo on Dix-Hallpike maneuver and none experienced cerebellar deficit, Tullio phenomenon, or Hennebert sign. All had documented osteoporosis or osteopenia by BMD scans. Three of them had definite osteoporosis, with T-scores < -2.5 in the axial spine, while another had osteopenia with a T-score of -2.3 in the left femur. CONCLUSIONS We describe an unusual presentation of SSCD without Tullio phenomenon or Hennebert sign in a population of elderly, East Asian women. There may be an association of SSCD and osteoporosis in this population. Further research is needed to determine the incidence and prevalence of this disorder, as well as the relationship of age, race, osteoporosis risk, and the development of SSCD.
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Affiliation(s)
- Alexander Yu
- South Cove Community Health Center, Boston, MA, USA
- Department of Neurology, Beth Israel Deaconess Medical Center, Boston, MA, USA
| | - Douglas L Teich
- Section of Neuroradiology/Department of Radiology, Beth Israel Deaconess Medical Center, Boston, MA, USA
| | - Gul Moonis
- Section of Neuroradiology/Department of Radiology, Beth Israel Deaconess Medical Center, Boston, MA, USA
| | - Eric T Wong
- South Cove Community Health Center, Boston, MA, USA
- Department of Neurology, Beth Israel Deaconess Medical Center, Boston, MA, USA
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Abstract
HYPOTHESIS High-resolution temporal bone computed tomography (CT) may erroneously demonstrate a superior semicircular canal dehiscence (SSCD) where none exists and inaccurately display the size of a dehiscence. BACKGROUND CT is an integral component of the diagnosis of SSCD. The prevalence of dehiscence as measured on computed tomographic scan is approximately eightfold higher than that on histologic studies, suggesting that CT may have a relatively low specificity for identifying canal dehiscence. This, in turn, can lead to an inappropriate diagnosis and treatment plan. METHODS We quantified the accuracy of CT in identifying a dehiscence of the superior semicircular canal in a cadaver model using microCT as a gold standard. The superior canals of 11 cadaver heads were blue lined. Twelve of the 22 ears were further drilled to create fenestrations of varying sizes. Heads were imaged using medical CT, followed by microCT scans of the temporal bones at 18-µm resolution. Diagnosis of dehiscence and measurements of dehiscence size were performed on clinical CT and compared with that of microCT. RESULTS Clinical CT identified 7 of 8 intact canals as dehiscent and tended to overestimate the size of smaller fenestrations, particularly those surrounded by thin bone. CONCLUSION These findings confirm that medical CT cannot be used as the exclusive gold standard for SSCD and that, particularly for small dehiscences on CT, clinical symptoms must be clearly indicative of a dehiscence before surgical treatment is undertaken. Preoperative counseling for small dehiscences may need to include the possibility that no dehiscence may be found despite radiologic evidence for it.
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79
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Anatomo-radiological study of the superior semicircular canal dehiscence of 37 cadaver temporal bones. Surg Radiol Anat 2012; 35:55-9. [DOI: 10.1007/s00276-012-0992-1] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/08/2011] [Accepted: 06/07/2012] [Indexed: 11/25/2022]
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80
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Manara R, Lionello M, de Filippis C, Citton V, Staffieri A, Marioni G. Superior semicircular canal dehiscence: a possible pathway for intracranial spread of infection. Am J Otolaryngol 2012; 33:263-5. [PMID: 21784554 DOI: 10.1016/j.amjoto.2011.05.006] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/23/2011] [Accepted: 05/18/2011] [Indexed: 10/17/2022]
Abstract
Otogenic brain abscesses account for 31.4% of all cerebral abscesses: bone erosion due to coalescent otomastoiditis or cholesteatomas, osteothrombophlebitis, and hematogenous spreading are the most frequent pathways of infection. We briefly reported and discussed the first case of otogenic brain abscess due to infectious labyrinthitis that (likely) spread intracranially through a dehiscence of the superior semicircular canal.
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81
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Muttikkal TE, Nicolasjilwan M. Congenital X-linked Stapes Gusher Syndrome in an Infant. Neuroradiol J 2012; 25:76-80. [DOI: 10.1177/197140091202500110] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/22/2011] [Accepted: 09/16/2011] [Indexed: 11/17/2022] Open
Abstract
Congenital X-linked deafness with stapes gusher is a rare, but well-known clinical entity with characteristic radiological features. Recognition of these findings is important as it changes the treatment course and precludes stapedectomy, which if done can lead to stapes gusher in these patients. We present the case of a nine-month-old male infant with hearing loss. CT scan showed typical radiological features of X-linked stapes gusher syndrome. In addition, the superior semicircular canals appeared dehiscent which could be due to immature ossification or less likely due to defective development as part of the disease. To the best of our knowledge this is the youngest patient prospectively identified by imaging in the English medical literature.
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Affiliation(s)
| | - M. Nicolasjilwan
- Radiology Department, University of Virginia; Charlottesville, Virginia, USA
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82
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Crovetto MA, Whyte J, Sarasola E, Rodriguez JA, García-Barcina MJ. Absence of COCH gene mutations in patients with superior semicircular canal dehiscence. Am J Med Genet A 2011; 158A:251-3. [DOI: 10.1002/ajmg.a.34377] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/23/2011] [Accepted: 10/17/2011] [Indexed: 12/23/2022]
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83
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Superior Canal Dehiscence Syndrome Associated With the Superior Petrosal Sinus in Pediatric and Adult Patients. Otol Neurotol 2011; 32:1312-9. [DOI: 10.1097/mao.0b013e31822e5b0a] [Citation(s) in RCA: 34] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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84
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Semicircular canal dehiscence in HR multislice computed tomography: distribution, frequency, and clinical relevance. Eur Arch Otorhinolaryngol 2011; 269:475-80. [PMID: 21739095 DOI: 10.1007/s00405-011-1688-6] [Citation(s) in RCA: 44] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/08/2011] [Accepted: 06/21/2011] [Indexed: 10/18/2022]
Abstract
The literature about bony defects in the semicircular canal system is highly inconsistent. Therefore, we analyzed a series of 700 high-resolution multislice CT examinations of the temporal bone for semicircular canal dehiscencies. An unselected group of ENT patients with different clinical symptoms and variable age was chosen. We found semicircular canal dehiscence in 9.6% of temporal bones, superior semicircular canal was affected mostly (8%), less common posterior semicircular canal (1.2%); only in 3 cases (0.4%), lateral semicircular canal showed dehiscence. In 60% of SSC dehiscence, we registered bilateral manifestation. The so-called "third mobile window" in semicircular canal dehiscence causes a great variety of clinical symptoms like vertigo, nystagmus, oscillopsies, hearing loss, tinnitus and autophonia. Comparison with anatomic studies shows that CT examination implies the risk of considerable overestimation; this fact emphasizes the important role of clinical and neurophysiological testing.
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Whyte Orozco J, Martínez C, Cisneros A, Obón J, Gracia-Tello B, Angel Crovetto M. Defecto de cobertura del canal semicircular superior y su implicación clínica. ACTA OTORRINOLARINGOLOGICA ESPANOLA 2011; 62:199-204. [DOI: 10.1016/j.otorri.2010.11.009] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/26/2010] [Revised: 11/18/2010] [Accepted: 11/20/2010] [Indexed: 10/18/2022]
Affiliation(s)
- Jaime Whyte Orozco
- Departamento de Anatomía e Histología Humanas, Facultad de Medicina, Universidad de Zaragoza, España.
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Defect of the Bony Roof in the Superior Semicircular Canal and Its Clinical Implications. ACTA OTORRINOLARINGOLOGICA ESPANOLA 2011. [DOI: 10.1016/j.otoeng.2010.11.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
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