Agrawal Sumit K, Parnes Lorne S
Department of Otolaryngology, University of Western Ontario, London, Canada.
Otol Neurotol. 2008 Apr;29(3):363-7. doi: 10.1097/mao.0b013e3181616c9d.
The traditional surgical repair for superior semicircular canal dehiscence (SSCD) involves either canal plugging or resurfacing via the middle cranial fossa approach. We describe a novel transmastoid occlusion technique.
Retrospective case review.
Tertiary referral center.
Three patients with symptomatic computed tomography-proven SSCD.
Transmastoid superior semicircular canal occlusion using bone pate in 2 fenestrations, with 1 placed on either side of the dehiscence.
Hearing and vestibular symptoms.
Two patients were primary cases of SSCD, and a third patient had failed a previous middle fossa occlusion using fascia at an outside institution. In all 3 cases, the 2 sides of the superior semicircular canal adjacent to the dehiscence were occluded using bone pate, formed from a mix of bone dust and fibrin sealant. This allowed for a permanent bony partition to be achieved between the dehiscence and the remainder of the labyrinth. In all cases, hearing was either preserved or improved, and the procedure was successful in controlling vestibular symptoms.
Transmastoid superior semicircular canal occlusion is a viable alternative to the customary middle fossa approach for superior canal dehiscence. Meticulous technique and the use of bone pate may help maximize auditory and vestibular results. Advantages of this technique include obviating a craniotomy, preclusion of temporal lobe retraction, familiarity of the approach for experienced otologists, and the ability to occlude the canal without manipulating the defect. The transmastoid approach for superior canal occlusion may not be possible when the dura is low hanging or when there is extensive cranial base dehiscence requiring reconstruction.
传统的后半规管裂（SSCD）手术修复方法包括通过中颅窝入路进行半规管堵塞或表面修复。我们描述一种新型经乳突封堵技术。
回顾性病例分析。
三级转诊中心。
3例经计算机断层扫描证实有症状的SSCD患者。
经乳突在2个开窗处使用骨糊封堵后半规管，1个开窗位于裂隙两侧。
听力和前庭症状。
2例患者为SSCD初发病例，第3例患者在外部机构曾使用筋膜进行中颅窝封堵但失败。在所有3例病例中，使用由骨粉和纤维蛋白密封剂混合制成的骨糊封堵与裂隙相邻的后半规管两侧。这使得在裂隙与迷路其余部分之间形成永久性骨分隔。在所有病例中，听力得以保留或改善，该手术成功控制了前庭症状。
经乳突后半规管封堵是后半规管裂传统中颅窝入路的一种可行替代方法。精细的技术和骨糊的使用可能有助于使听觉和前庭效果最大化。该技术的优点包括避免开颅、避免颞叶牵拉、经验丰富的耳科医生熟悉该入路以及能够在不处理缺损的情况下封堵半规管。当硬脑膜低垂或存在需要重建的广泛颅底裂时，经乳突入路进行半规管封堵可能不可行。
