Thien Nguyen1,2,3, Carlito Lagman1, John P Sheppard1,2,3, Prasanth Romiyo1, Courtney Duong1, Giyarpuram N Prashant1, Quinton Gopen4, Isaac Yang5,6,7,8,9,10,11. 1. Department of Neurosurgery, University of California, Los Angeles, Los Angeles, CA, USA. 2. David Geffen School of Medicine, University of California, Los Angeles, Los Angeles, CA, USA. 3. Los Angeles Biomedical Research Institute (LA BioMed), Harbor-UCLA Medical Center, Torrance, CA, USA. 4. Department of Head and Neck Surgery, University of California, Los Angeles, Los Angeles, CA, USA. 5. Department of Neurosurgery, University of California, Los Angeles, Los Angeles, CA, USA. iyang@mednet.ucla.edu. 6. David Geffen School of Medicine, University of California, Los Angeles, Los Angeles, CA, USA. iyang@mednet.ucla.edu. 7. Los Angeles Biomedical Research Institute (LA BioMed), Harbor-UCLA Medical Center, Torrance, CA, USA. iyang@mednet.ucla.edu. 8. Department of Head and Neck Surgery, University of California, Los Angeles, Los Angeles, CA, USA. iyang@mednet.ucla.edu. 9. Department of Radiation Oncology, University of California, Los Angeles, Los Angeles, CA, USA. iyang@mednet.ucla.edu. 10. Jonsson Comprehensive Cancer Center, Ronald Reagan UCLA Medical Center, University of California, Los Angeles, Los Angeles, CA, USA. iyang@mednet.ucla.edu. 11. Department of Neurosurgery, Harbor-UCLA Medical Center, Torrance, CA, USA. iyang@mednet.ucla.edu.
Abstract
BACKGROUND: Superior semicircular canal dehiscence (SSCD) is a disorder of the skull base that is gaining increasing recognition among neurosurgeons. Traditionally, the middle cranial fossa (MCF) approach has been used for the surgical repair of SSCD. However, the transmastoid (TM) approach is an alternative strategy that has demonstrated promising results. METHODS: We performed independent searches of a popular database to identify studies that described outcomes following the surgical repair of SSCD through MCF and TM approaches. The primary outcome was symptom resolution. RESULTS: Our analysis included 24 studies that described 230 patients that underwent either an MCF (n = 148, 64%) approach or a TM (n = 82, 36%) approach for primary surgical repair of SSCD. A greater percentage of patients in the MCF group experienced resolution of auditory symptoms (72% vs 59%, p = 0.012), aural fullness (83% vs 55%, p = 0.049), hearing loss (57% vs 31%, p = 0.026), and disequilibrium (75% vs 44%, p = 0.001) when compared to the TM group. The MCF approach was also associated with higher odds of symptom resolution for auditory symptoms (odds ratio [OR] 1.79, 95% confidence interval [CI] 1.14-2.82), aural fullness (OR 4.02, 95% CI 1.04-15.53), hearing loss (OR 2.91, 95% CI 1.14-7.42), and disequilibrium (OR 3.94, 95% CI 1.78-8.73). The mean follow-up was 9 months. CONCLUSIONS: The literature suggests that the MCF approach for the repair of SSCD is associated with greater symptom resolution when compared to the TM approach. This information could help facilitate patient discussions.
BACKGROUND: Superior semicircular canal dehiscence (SSCD) is a disorder of the skull base that is gaining increasing recognition among neurosurgeons. Traditionally, the middle cranial fossa (MCF) approach has been used for the surgical repair of SSCD. However, the transmastoid (TM) approach is an alternative strategy that has demonstrated promising results. METHODS: We performed independent searches of a popular database to identify studies that described outcomes following the surgical repair of SSCD through MCF and TM approaches. The primary outcome was symptom resolution. RESULTS: Our analysis included 24 studies that described 230 patients that underwent either an MCF (n = 148, 64%) approach or a TM (n = 82, 36%) approach for primary surgical repair of SSCD. A greater percentage of patients in the MCF group experienced resolution of auditory symptoms (72% vs 59%, p = 0.012), aural fullness (83% vs 55%, p = 0.049), hearing loss (57% vs 31%, p = 0.026), and disequilibrium (75% vs 44%, p = 0.001) when compared to the TM group. The MCF approach was also associated with higher odds of symptom resolution for auditory symptoms (odds ratio [OR] 1.79, 95% confidence interval [CI] 1.14-2.82), aural fullness (OR 4.02, 95% CI 1.04-15.53), hearing loss (OR 2.91, 95% CI 1.14-7.42), and disequilibrium (OR 3.94, 95% CI 1.78-8.73). The mean follow-up was 9 months. CONCLUSIONS: The literature suggests that the MCF approach for the repair of SSCD is associated with greater symptom resolution when compared to the TM approach. This information could help facilitate patient discussions.
Entities:
Keywords:
Cranial Fossa; Middle; Neurosurgery; Semicircular canal; Skull base
Authors: Joel S Beckett; Carlito Lagman; Lawrance K Chung; Timothy T Bui; Seung J Lee; Brittany L Voth; Bilwaj Gaonkar; Quinton Gopen; Isaac Yang Journal: J Neurol Surg B Skull Base Date: 2016-12-07