Dallas Ear Institute
7777 Forest Lane, Suite A-103, Dallas, TX 75230 | Phone: (972) 566-7600 | Fax: (972) 566-6560 | www.dallasear.com

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Superior Canal Dehiscence Syndrome Case Number 1

An incision is made behind the ear in the crease. This is hidden in this area so that it is not visible postoperatively. The periosteum, or soft tissue covering over the bone, is elevated to gain access to the mastoid bone.

The mastoid is opened with a high speed drill utilizing both cutting and diamond burs. The wall between the ear canal and mastoid is thinned appropriately. The bony semicircular canals are exposed (yellow arrow). As can be seen in this representative case, the bone separating the dura of the brain and the mastoid cavity is often thin in patients with superior semicircular canal dehiscence (red arrow).

A small opening in the bone between the mastoid cavity and the brain cavity is made to gain access to the dehiscence of the superior semicircular canal (yellow arrow). This small opening is made just outside of where the semicircular canal resides.

The dehiscence is clearly visualized using a micro-endoscope (black arrow). The dura is carefully elevated from the underlying semicircular canal in preparation for resurfacing (yellow arrow).

Another photo showing the bony canal dehiscence.

The dura is carefully elevated using an atraumatic instrument. The area of the superior semicircular canal is known because the bony canal is identified within the mastoid and location correlated.

In preparation for resurfacing, the grafts are set up. A cartilage graft is harvested from the tragus, a fascial graft is taken from the temporalis fascia, and bone pate saved during drilling of the mastoid cavity.
The cartilage graft is placed into the mini-craniotomy site and used as a cap over the superior semicircular canal dehiscence (black arrow).

Fascia graft is spread over the exposed superior semicircular canal and used to resurface this area (black arrow).

The resurfacing procedure is complete (yellow arrow). 

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Dallas Ear Institute
7777 Forest Lane, Suite A-103, Dallas, TX 75230 | Phone: (972) 566-7600 | Fax: (972) 566-6560 | www.dallasear.com