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Mozaffari K, Zhang AB, Wilson B, Harary M, Chandla A, Umesh A, Gopen Q, Yang I. Evaluation of Superior Semicircular Canal Dehiscence Anatomical Location and Clinical Outcomes: A Single Institution's Experience. World Neurosurg 2022; 167:e865-e870. [PMID: 36031116 DOI: 10.1016/j.wneu.2022.08.090] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/05/2022] [Accepted: 08/20/2022] [Indexed: 10/31/2022]
Abstract
BACKGROUND Superior semicircular canal dehiscence (SSCD) is becoming increasingly recognized as a pathology underlying various auditory and vestibular complaints. To date, our understanding of the pathology has yet to attribute specific symptoms to the anatomic location of dehiscence in patients with SSCD. This study aims to address this issue by evaluating the relationship between symptomatology and anatomic location of dehiscence. METHODS A single-institution retrospective review of SSCD patients was performed. Information was collected on patient demographics, symptomatology, and anatomic location of dehiscence. High-resolution computed tomography scans of the temporal bones were used to categorize the anatomic SSCD location into 1 of 3 groups: anterior limb, apex, and posterior limb. Lastly, we performed statistical analysis to determine the degree of association between each of the various perioperative factors and anatomic SSCD location. RESULTS We studied 54 patients in total (32 women, 22 men). Mean age at diagnosis was 53 years (range: 20-82 years) and mean follow-up length was 5.5 months (range: 0.03-27.0 months). The most common anatomical location of superior semicircular canal dehiscence was the apex, which was seen in 68.5% of cases. While preoperative symptomatology was similar among the 3 cohorts, those with apical dehiscences had a significantly higher rate of postoperative improvement of autophony (P = 0.03), aural fullness (P = 0.03), and tinnitus (P = 0.05) as compared to their counterparts. CONCLUSIONS Although our results do not support an association between preoperative characteristics-including symptomatology-and anatomic SSCD location, our findings do suggest that apical dehiscences are associated with greater postoperative symptomatic resolution.
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Affiliation(s)
| | - Ashley B Zhang
- Department of Neurosurgery, Los Angeles, California, USA
| | - Bayard Wilson
- Department of Neurosurgery, Los Angeles, California, USA
| | - Maya Harary
- Department of Neurosurgery, Los Angeles, California, USA
| | | | - Amith Umesh
- Department of Neurosurgery, Los Angeles, California, USA
| | - Quinton Gopen
- Department of Head and Neck Surgery, Los Angeles, California, USA
| | - Isaac Yang
- Department of Neurosurgery, Los Angeles, California, USA; Department of Head and Neck Surgery, Los Angeles, California, USA; David Geffen School of Medicine, Los Angeles, California, USA; Department of Radiation Oncology, Los Angeles, California, USA; Jonsson Comprehensive Cancer Center, Ronald Reagan UCLA Medical Center, Los Angeles, California, USA; Los Angeles Biomedical Research Institute (LA BioMed) at Harbor-UCLA Medical Center, University of California, Los Angeles, Los Angeles, CA, United States.
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Mozaffari K, Willis SL, Unterberger A, Duong C, Hong M, De Jong R, Mekonnen M, Johanis M, Miao T, Yang I, Gopen Q. Superior Semicircular Canal Dehiscence Outcomes in a Consecutive Series of 229 Surgical Repairs With Middle Cranial Fossa Craniotomy. World Neurosurg 2021; 156:e229-e234. [PMID: 34547526 DOI: 10.1016/j.wneu.2021.09.038] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/24/2021] [Revised: 09/07/2021] [Accepted: 09/08/2021] [Indexed: 01/12/2023]
Abstract
BACKGROUND Superior semicircular canal dehiscence (SSCD) is the appearance of a third mobile window between the middle fossa and the superior semicircular canal. Surgical management is indicated in patients with persistent and debilitating symptoms. The purpose of this study was to evaluate the association between preoperative variables that may impact postoperative symptomatic resolution. METHODS A single-institution retrospective analysis was performed on patients who were surgically treated for SSCD. Patients were divided to different cohorts based on unilateral or bilateral nature of the disease. A P value <0.05 was considered statistically significant. RESULTS A total of 229 surgical repairs were analyzed. Mean age was 51 years (± 7.8 years), and 55.9% of patients were female. All cohorts were similar with respect to baseline demographics. The most commonly reported preoperative symptoms were tinnitus, dizziness, and autophony. The greatest symptomatic resolution was seen in autophony, internal sound amplification, hyperacusis, and oscillopsia. The unilateral SSCD cohort had significantly higher improvement of autophony (P = 0.003), aural fullness (P = 0.05), tinnitus (P = 0.006), hearing loss (P = 0.02), dizziness (P = 0.006), and headache (P = 0.007), compared with the bilateral SSCD cohorts. Among patients with bilateral disease, those with unilateral surgery reported greater symptomatic resolution with respect to hyperacusis (P = 0.03), hearing loss (P = 0.02), dizziness (P = 0.03), and disequilibrium (P < 0.001), than those with bilateral operations. CONCLUSIONS Surgical management of SSCD leads to high rates of postoperative symptomatic improvement. Patients with unilateral SSCD benefit greater symptomatic resolution compared to those with bilateral pathology.
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Affiliation(s)
- Khashayar Mozaffari
- Department of Neurosurgery, Ronald Reagan UCLA Medical Center, University of California, Los Angeles, California, USA
| | - Shelby L Willis
- Department of Head and Neck Surgery, Ronald Reagan UCLA Medical Center, University of California, Los Angeles, California, USA
| | - Ansley Unterberger
- Department of Neurosurgery, Ronald Reagan UCLA Medical Center, University of California, Los Angeles, California, USA
| | - Courtney Duong
- Department of Neurosurgery, Ronald Reagan UCLA Medical Center, University of California, Los Angeles, California, USA
| | - Michelle Hong
- Department of Head and Neck Surgery, Ronald Reagan UCLA Medical Center, University of California, Los Angeles, California, USA
| | - Russell De Jong
- Department of Head and Neck Surgery, Ronald Reagan UCLA Medical Center, University of California, Los Angeles, California, USA
| | - Mahlet Mekonnen
- Department of Neurosurgery, Ronald Reagan UCLA Medical Center, University of California, Los Angeles, California, USA
| | - Michael Johanis
- Department of Head and Neck Surgery, Ronald Reagan UCLA Medical Center, University of California, Los Angeles, California, USA
| | - Tyler Miao
- Department of Head and Neck Surgery, Ronald Reagan UCLA Medical Center, University of California, Los Angeles, California, USA
| | - Isaac Yang
- Department of Neurosurgery, Ronald Reagan UCLA Medical Center, University of California, Los Angeles, California, USA; Department of Head and Neck Surgery, Ronald Reagan UCLA Medical Center, University of California, Los Angeles, California, USA; David Geffen School of Medicine, Ronald Reagan UCLA Medical Center, University of California, Los Angeles, California, USA; Department of Radiation Oncology, Ronald Reagan UCLA Medical Center, University of California, Los Angeles, California, USA; Jonsson Comprehensive Cancer Center, Ronald Reagan UCLA Medical Center, University of California, Los Angeles, California, USA; Los Angeles Biomedical Research Institute (LA BioMed) at Harbor-UCLA Medical Center, University of California, Los Angeles, California, USA.
| | - Quinton Gopen
- Department of Head and Neck Surgery, Ronald Reagan UCLA Medical Center, University of California, Los Angeles, California, USA
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