Ung Nolan, Chung Lawrance K, Lagman Carlito, Bhatt Nikhilesh S, Barnette Natalie E, Ong Vera, Gopen Quinton, Yang Isaac
Department of Neurosurgery, University of California, Los Angeles, 300 Stein Plaza, 5th Floor Wasserman Bldg., Los Angeles, CA 90095-6901, United States.
Department of Neurosurgery, University of California, Los Angeles, 300 Stein Plaza, 5th Floor Wasserman Bldg., Los Angeles, CA 90095-6901, United States; Department of Head and Neck Surgery, University of California, Los Angeles, 200 UCLA Medical Plaza, Suite 550, Los Angeles, CA 90095-6901, United States.
J Clin Neurosci. 2017 Sep;43:103-107. doi: 10.1016/j.jocn.2017.05.003. Epub 2017 Jun 13.
Superior semicircular canal dehiscence (SSCD) is a rare defect of the arcuate eminence that causes an abnormal connection between the superior semicircular canal and middle cranial fossa. Patients often present with a variety of auditory and vestibular symptoms. Trigger avoidance is the initial strategy, but surgery may be necessary in debilitating cases. We retrospectively reviewed SSCD patients undergoing repair via a middle fossa craniotomy between March 2011 and September 2015. Forty-nine patients undergoing 58 surgeries were identified. Autophony was the most common symptom at presentation (n=44; 90%). Mean follow-up was 10.9months, with 100% of patients reporting resolution of at least one symptom. Aural fullness was the most commonly resolved symptom following surgical repair (n=19/22; 86%). Hearing loss (n=11/25; 44%) and tinnitus (n=11/38; 29%) were the most common symptoms to persist following surgery. The most common symptom to develop after surgery was disequilibrium (n=4/18; 22%). Upon comparing the overall pre-operative and post-operative groups, the number of patients with autophony (p<0.0001), aural fullness (p=0.0006), hearing loss (p=0.0119), disequilibrium (p=0.0002), sound- and pressure-induced vertigo (p<0.0001), and tinnitus (p<0.0001) were significantly different. Improved clinical outcomes were demonstrated in patients undergoing SSCD repair through a middle cranial fossa approach. The most common presenting symptom (autophony) was also most likely to resolve after surgery. Hearing loss is less amenable to surgical correction. Disequilibrium developed in a small number of patients after repair.
上半规管裂（SSCD）是一种罕见的弓状隆起缺陷，导致上半规管与中颅窝之间出现异常连接。患者常出现各种听觉和前庭症状。避免触发因素是初始策略，但在症状严重的病例中可能需要手术。我们回顾性分析了2011年3月至2015年9月期间接受中颅窝开颅修复术的SSCD患者。共确定了49例患者，接受了58次手术。耳内自听过响是最常见的就诊症状（n = 44；90%）。平均随访时间为10.9个月，100%的患者报告至少一种症状得到缓解。耳闷是手术修复后最常缓解的症状（n = 19/22；86%）。听力损失（n = 11/25；44%）和耳鸣（n = 11/38；29%）是术后最常见的持续症状。术后最常见的新发症状是平衡失调（n = 4/18；22%）。比较术前和术后总体患者组，耳内自听过响（p < 0.0001）、耳闷（p = 0.0006）、听力损失（p = 0.0119）、平衡失调（p = 0.0002）、声音和压力诱发的眩晕（p < 0.0001）以及耳鸣（p < 0.0001）的患者数量存在显著差异。通过中颅窝入路进行SSCD修复的患者临床结果得到改善。最常见的就诊症状（耳内自听过响）术后也最有可能缓解。听力损失较难通过手术矫正。少数患者修复后出现平衡失调。
