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J Neurol Surg B Skull Base
DOI: 10.1055/a-2430-0394
Original Article

Surgical Technique for Repair of Tegmen Dehiscence with Encephalocele: A Retrospective Study

Marcelle Altshuler
1   Department of Neurosurgery, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts, United States
,
Rohan Jha
2   Harvard Medical School, Boston, Massachusetts, United States
,
Saksham Gupta
1   Department of Neurosurgery, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts, United States
,
Christopher S. Hong
1   Department of Neurosurgery, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts, United States
,
Kaasinath Balagurunath
3   Boston University, Boston, Massachusetts, United States
,
Jakob V.E. Gerstl
1   Department of Neurosurgery, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts, United States
,
Yohan Song
4   Department of Otolaryngology, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts, United States
,
Eduardo Corrales
4   Department of Otolaryngology, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts, United States
,
Timothy Smith
1   Department of Neurosurgery, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts, United States
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Abstract

Background and Objectives Tegmen dehiscence with encephalocele presents certain surgical challenges, necessitating innovative approaches to improve patient outcomes and minimize complications. Here we aim to evaluate the safety and efficacy of a novel middle cranial fossa craniotomy technique.

Methods Nineteen adult patients with radiographically confirmed tegmen dehiscence with encephalocele were included. Patients underwent a middle cranial fossa craniotomy technique for tegmen dehiscence repair, utilizing a split-thickness bone graft, pedicled pericranial flap, and hydroxyapatite for extradural repair and with an inlay graft for the intradural repair. The primary outcome measured was the major perioperative complications or need for revision surgery, while the secondary outcome measured was the resolution or improvement of preoperative symptoms associated with tegmen dehiscence.

Results Our series encompassed tegmen dehiscence repairs in 19 patients, with an average age at surgery of 51 years (range: 24–82 years). The average follow-up time was 8.80 months (range: 0.43–27.62 months). Patients commonly presented with symptoms such as hearing loss (n = 8), otorrhea (n = 8), fullness or ear pressure (n = 6), dizziness or imbalance (n = 6), or a history of meningitis (n = 4), among others. Postoperatively, symptoms resolved completely in 42% of patients (n = 8) and partially in 58% of patients (n = 11). Notably, no patients required revision surgery or developed new dehiscence in the follow-up period.

Conclusion Our middle cranial fossa craniotomy technique for tegmen dehiscence with encephalocele repair demonstrated promising postoperative outcomes, with complete or partial symptom resolution in all patients and no major complications. Our findings suggest that this technique is a safe and effective approach for tegmen dehiscence repair.

Keywords

encephalocele - hydroxyapatite - middle fossa craniotomy - novel surgical technique - pedicled pericranial flap - split-thickness bone graft - tegmen dehiscence


Publication History

Received: 30 June 2024

Accepted: 27 September 2024

Accepted Manuscript online:
01 October 2024

Article published online:
22 October 2024

© 2024. Thieme. All rights reserved.

Georg Thieme Verlag KG
Rüdigerstraße 14, 70469 Stuttgart, Germany

 

  • References

  • 1 Nadgir RN, Ozonoff A, Devaiah AK, Halderman AA, Sakai O. Superior semicircular canal dehiscence: congenital or acquired condition?. AJNR Am J Neuroradiol 2011; 32 (05) 947-949
    CrossrefPubMedSearch in Google Scholar
  • 2 Stimmer H, Hamann KF, Zeiter S, Naumann A, Rummeny EJ. Semicircular canal dehiscence in HR multislice computed tomography: distribution, frequency, and clinical relevance. Eur Arch Otorhinolaryngol 2012; 269 (02) 475-480
    CrossrefPubMedSearch in Google Scholar
  • 3 Williamson RA, Vrabec JT, Coker NJ, Sandlin M. Coronal computed tomography prevalence of superior semicircular canal dehiscence. Otolaryngol Head Neck Surg 2003; 129 (05) 481-489
    CrossrefPubMedSearch in Google Scholar
  • 4 Loke SC, Goh JPN. Incidence of semicircular canal dehiscence in Singapore. Br J Radiol 2009; 82 (977) 371-373
    CrossrefPubMedSearch in Google Scholar
  • 5 Ceylan N, Bayraktaroglu S, Alper H. et al. CT imaging of superior semicircular canal dehiscence: added value of reformatted images. Acta Otolaryngol 2010; 130 (09) 996-1001
    CrossrefPubMedSearch in Google Scholar
  • 6 Gartrell BC, Gentry LR, Kennedy TA, Gubbels SP. Radiographic features of superior semicircular canal dehiscence in the setting of chronic ear disease. Otol Neurotol 2014; 35 (01) 91-96
    CrossrefPubMedSearch in Google Scholar
  • 7 Berning AW, Arani K, Branstetter IV BF. Prevalence of superior semicircular canal dehiscence on high-resolution CT imaging in patients without vestibular or auditory abnormalities. AJNR Am J Neuroradiol 2019; 40 (04) 709-712
    PubMedSearch in Google Scholar
  • 8 Masaki Y. The prevalence of superior canal dehiscence syndrome as assessed by temporal bone computed tomography imaging. Acta Otolaryngol 2011; 131 (03) 258-262
    CrossrefPubMedSearch in Google Scholar
  • 9 Carey JP, Minor LB, Nager GT. Dehiscence or thinning of bone overlying the superior semicircular canal in a temporal bone survey. Arch Otolaryngol Head Neck Surg 2000; 126 (02) 137-147
    CrossrefPubMedSearch in Google Scholar
  • 10 Crovetto M, Whyte J, Rodriguez OM, Lecumberri I, Martinez C, Eléxpuru J. Anatomo-radiological study of the superior semicircular canal dehiscence radiological considerations of superior and posterior semicircular canals. Eur J Radiol 2010; 76 (02) 167-172
    CrossrefPubMedSearch in Google Scholar
  • 11 Nomiya S, Cureoglu S, Kariya S. et al. Posterior semicircular canal dehiscence: a histopathologic human temporal bone study. Otol Neurotol 2010; 31 (07) 1122-1127
    CrossrefPubMedSearch in Google Scholar
  • 12 Saxby AJ, Gowdy C, Fandiño M. et al. Radiological prevalence of superior and posterior semicircular canal dehiscence in children. Int J Pediatr Otorhinolaryngol 2015; 79 (03) 411-418
    CrossrefPubMedSearch in Google Scholar
  • 13 Chen EY, Paladin A, Phillips G. et al. Semicircular canal dehiscence in the pediatric population. Int J Pediatr Otorhinolaryngol 2009; 73 (02) 321-327
    CrossrefPubMedSearch in Google Scholar
  • 14 Hagiwara M, Shaikh JA, Fang Y, Fatterpekar G, Roehm PC. Prevalence of radiographic semicircular canal dehiscence in very young children: an evaluation using high-resolution computed tomography of the temporal bones. Pediatr Radiol 2012; 42 (12) 1456-1464
    CrossrefPubMedSearch in Google Scholar
  • 15 Aladham Y, Ahmed O, Hassan SAS, Francis-Khoury E. Traumatic superior semicircular canal dehiscence syndrome: case report and literature review. J Surg Case Rep 2021; 2021 (01) rjaa592
    CrossrefPubMedSearch in Google Scholar
  • 16 Crovetto-De la Torre MA, Whyte-Orozco J, Crovetto-Martínez R, Whyte-Orozco A, Obón-Nogués JA, Martínez-Rodríguez A. A new cause of structural vertigo: superior semicircular canal dehiscence. Rev Neurol 2011; 52 (12) 751-758
    PubMedSearch in Google Scholar
  • 17 Yu A, Teich DL, Moonis G, Wong ET. Superior semicircular canal dehiscence in East Asian women with osteoporosis. BMC Ear Nose Throat Disord 2012; 12: 8
    CrossrefPubMedSearch in Google Scholar
  • 18 Schutt CA, Neubauer P, Samy RN. et al. The correlation between obesity, obstructive sleep apnea, and superior semicircular canal dehiscence: a new explanation for an increasingly common problem. Otol Neurotol 2015; 36 (03) 551-554
    CrossrefPubMedSearch in Google Scholar
  • 19 Oh MS, Vivas EX, Hudgins PA, Mattox DE. The prevalence of superior semicircular canal dehiscence in patients with mastoid encephalocele or cerebrospinal fluid otorrhea. Otol Neurotol 2019; 40 (04) 485-490
    CrossrefPubMedSearch in Google Scholar
  • 20 Kuo P, Bagwell KA, Mongelluzzo G. et al. Semicircular canal dehiscence among idiopathic intracranial hypertension patients. Laryngoscope 2018; 128 (05) 1196-1199
    CrossrefPubMedSearch in Google Scholar
  • 21 Berkiten G, Gürbüz D, Akan O. et al. Dehiscence or thinning of bone overlying the superior semicircular canal in idiopathic intracranial hypertension. Eur Arch Otorhinolaryngol 2022; 279 (06) 2899-2904
    CrossrefPubMedSearch in Google Scholar
  • 22 Lim ZM, Friedland PL, Boeddinghaus R, Thompson A, Rodrigues SJ, Atlas M. Otitic meningitis, superior semicircular canal dehiscence, and encephalocele: a case series. Otol Neurotol 2012; 33 (04) 610-612
    CrossrefPubMedSearch in Google Scholar
  • 23 Handzel O, Brenner-Ullman A, Cavel O. et al. Clinical implications of the association between temporal bone tegmen defects and superior semicircular canal dehiscence. Otol Neurotol 2018; 39 (06) 797-802
    CrossrefPubMedSearch in Google Scholar
  • 24 Locketz G, Margalit N, Gonen L, Fliss DM, Handzel O. Dilemmas in the treatment of concurrent bilateral meningoencephalocele and superior semicircular canal dehiscence. Otol Neurotol 2015; 36 (05) 932-935
    CrossrefPubMedSearch in Google Scholar
  • 25 Nguyen T, Lagman C, Sheppard JP. et al. Middle cranial fossa approach for the repair of superior semicircular canal dehiscence is associated with greater symptom resolution compared to transmastoid approach. Acta Neurochir (Wien) 2018; 160 (06) 1219-1224
    CrossrefPubMedSearch in Google Scholar
  • 26 Hong M, Mozaffari K, Uy B. et al. Postoperative outcomes of patients with thin bone overlying the superior semicircular canal: a single institution's experience. World Neurosurg 2022; 166: e93-e98
    CrossrefPubMedSearch in Google Scholar
  • 27 Al Afif A, Farmer R, Bance M. Outcomes of transmastoid resurfacing for superior canal dehiscence using a cartilage overlay technique. Laryngoscope 2019; 129 (09) 2164-2169
    CrossrefPubMedSearch in Google Scholar
  • 28 Trieu V, Pelargos PE, Spasic M. et al. Minimally invasive middle fossa keyhole craniectomy for repair of superior semicircular canal dehiscence. Oper Neurosurg (Hagerstown) 2017; 13 (03) 317-323
    CrossrefPubMedSearch in Google Scholar
  • 29 Creighton Jr FX, Zhang L, Ward B, Carey JP. Hearing outcomes for an underwater endoscopic technique for transmastoid repair of superior semicircular canal dehiscence. Otol Neurotol 2021; 42 (10) e1691-e1697
    CrossrefPubMedSearch in Google Scholar
  • 30 Totten DJ, Smetak MR, Manzoor NF. et al. Endoscope-assisted superior semicircular canal dehiscence repair: single institution outcomes. Ann Otol Rhinol Laryngol 2022; 131 (07) 743-748
    CrossrefPubMedSearch in Google Scholar