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Management of superior canal dehiscence syndrome with extensive skull-base deficiency.

Pletcher SD, Oghalai JS, Reeck JB, Cheung SW

Department of Otolaryngology-Head and Neck Surgery, University of California, San Francisco, Calif. 94143-0342, USA. spletcher@ohns.ucsf.edu

Superior canal dehiscence syndrome is a recently described condition resulting in noise- or pressure-induced vertigo. We review the case of a 50-year-old woman who presented with debilitating pressure and noise-induced vertigo as well as a low-frequency conductive hearing loss. Imaging was consistent with superior semicircular canal dehiscence syndrome. An extradural middle fossa approach was used to approach the dehiscent superior canal. Intraoperatively, our patient was found to have extensive idiopathic skull base dehiscence of the temporal floor. Middle ear and mastoid mucosa was exposed with focal areas of dura prolapsed into the mastoid cavity. Because of these findings, temporalis fascia and bone pate were used to cover the dehiscent canal as well as a large area of the temporal floor. Additionally, a temporalis muscle flap was rotated between the dura and the dehiscent temporal floor to reconstruct the middle fossa skull base and prevent encephalocele.

Published 18 November 2005 in ORL J Otorhinolaryngol Relat Spec, 67(4): 192-5.
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