Surgical repair via endoscopic middle fossa approach
La superior semicircular canal dehiscence (SSCD) It is a rare otoneurological condition characterized by an abnormal communication between the bony labyrinth and the middle cranial fossa. This defect gives rise to what is known as third window syndromeresponsible for complex auditory and vestibular symptoms. In the platform SURGSCHOOL, the most innovative medical app for surgeries internationally’s most emblematic landmarks, the Dr. Juan Casado (Miguel Servet University Hospital in Zaragoza, Spain) presents a surgery of bilateral DCSS repair through a endoscopic approach to the middle fossa, a technique that combines microsurgical precision and minimal invasiveness.
Anatomy and pathophysiology of superior semicircular canal dehiscence
The superior semicircular canal is in close relation to the tegmen timpani and arcuate eminence, areas susceptible to bone thinning or congenital or acquired discontinuities.
The loss of integrity of this labyrinthine wall creates a “third window” that alters the transmission of acoustic and vestibular energy, producing bone hyperacusis, sound-induced vertigo (Tullio syndrome) and postural imbalance.
Diagnosis and patient selection
Diagnosis is made by high-resolution computed tomography in Pöschl and Stenvers planes, confirming the bone discontinuity. In this case, the patient—a 44-year-old male with a history of Chiari malformation and frontal arteriovenous malformation—presented bilateral symptoms consistent with third window syndrome.
The imaging study revealed a bilateral dehiscence of the superior semicircular canal, with a left-sided predominance.
Surgical technique: endoscopic approach to the middle fossa
El Dr. Casado he made a mini-temporal craniotomy for endoscopic middle fossa approach with 30º optics.
After exposure of the tegmen and arcuate eminence, the dehiscence was identified and the following procedure was carried out repair the defect with bone chips and temporal fasciasealing the affected channel without compromising adjacent labyrinthine structures.
During the intervention, the following was monitored: intracranial pressurewhich was elevated (30 mmHg), which is why it was performed lumbar puncture and drainage, and subsequently it was indicated the placement of a lumboperitoneal shunt for the management of associated intracranial hypertension.
Results and postoperative evolution
The patient presented good clinical evolutionThe patient experienced controlled vestibular symptoms and no neurological complications. He was discharged 48 hours after the procedure.
El use of endoscopy This approach allowed for a wider view with minimal temporary retraction, improving safety and reducing surgical time.
La Endoscopic repair of superior semicircular canal dehiscence through middle fossa approach It represents a safe and effective alternative, especially in bilateral cases or those associated with intracranial hypertension.
Technique Dr. Juan Casado, available in full video at SurgSchoolexemplifies the precision and rigor of modern otoneurosurgical surgery.
