Superior Semicircular Canal Dehiscence

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Let's discuss repair of the superior semicircular canal dehiscence via the middle fossa approach. In this disease the patient usually suffers from intractable vertigo and decreased hearing on the affected side. This is a 41 year old male with intractable vertigo and nystagmus as well as left sided hearing loss. The pathophysiology of this disease involves thinning or absence of temporal bone over the semicircular canal roof. You can see the arrow points in the area where the bone over the roof of the superior semicircular canal is missing. You can see the linear incision. Just anterior to the ear, a lumbar drain was installed, a middle fossa craniotomy was completed. The overhanging bone in the inferior aspect of the craniotomy was drilled away so that an unobstructed view of the middle fossa can be reached. All the air cells were well waxed. A duro was gently elevated from the middle fossa floor and the area of their superior semicircular canals were found. Here's a more magnified view of the bone over the semicircular canals. You can see that bone is missing in this area. Another demagnified view of the pathology. I usually use a piece of wax to cover the area. This is reinforced with piece of Cottonoid. Additional pieces of wax may also be used. Subsequently a piece of bone is placed over the area of the dehiscence. Fibrin glue is used to keep the piece of bone in place. Here's the final result. The air cells are adequately rewaxed. And this procedure is quite effective in patients who are well selected for the procedure. Thank you.

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