经乳突入路手术治疗上半规管裂综合征10例临床特点及治疗效果分析

目的 探讨上半规管裂综合征(superior semicircular canal dehiscence syndrome, SSCDS)患者的临床特点,并分析经乳突入路手术治疗的治疗效果。方法 回顾性分析2015年5月至2021年9月期间,于首都医科大学附属北京友谊医院耳鼻咽喉头颈外科行手术治疗的SSCDS患者的临床资料,并进行了术后随访。手术方法包括经乳突入路上半规管裂修补术和上半规管阻塞术。根据患者术后症状改善情况,疗效分为痊愈、好转和无效。结果 本研究共有10例患者,其中男性5例,女性5例。9例为单侧SSCDS,1例为双侧SSCDS。常见症状包括骨导听觉过敏、血管搏动性耳鸣、强声诱发眩晕以及中耳或者颅内压力变化引起眩晕。10例患者均为单侧手术,4例患者行经乳突入路上半规管裂修补术,其余6例患者行经乳突入路上半规管阻塞术。术后有1例患者失访。随访的9例患者中,随访时长为4~73个月,术后5例痊愈,3例好转,1例无效。术后无效的可能原因为该患者颅中窝低位,经乳突入路上半规管裂修补术中暴露硬脑膜与弓状隆起之间的间隙困难,导致修补不到位。所有患者术后均无脑脊液漏或颅内感染等严重并发症。结论 经乳突入路上半规管裂修补术和上半规管阻塞术均是安全有效的。相比之下,上半规管阻塞术操作更简单,尤其是对于颅中窝低位的患者,建议行上半规管阻塞术。

Clinical characteristics and surgical outcome of 10 cases of superior semicircular canal dehiscence syndrome treated via transmastoid approach

Objective To investigate clinical characteristics of patients with superior semicircular canal dehiscence syndrome (SSCDS), and to analyze the surgical outcome of the transmastoid approach. Methods From May 2015 to September 2021, the clinical data of SSCDS patients who underwent surgical treatments in Department of Otolaryngology-Head and Neck Surgery, Beijing Friendship Hospital, Capital Medical University were retrospectively analyzed, and postoperative follow-ups were conducted. Surgical methods included the repair of the superior semicircular canal dehiscence and the occlusion of superior semicircular canal via transmastoid approach. According to the improvement of patients' symptoms after operation, the postoperative effect was divided into three types (cured, improved and invalid). Results There were 10 patients in the study, including 5 males and 5 females. Nine cases had unilateral SSCDS, and the remaining one had bilateral SSCDS. Common symptoms were bone-conduction hyperacusis, vascular pulsatile tinnitus, vertigo induced by loud sounds, and vertigo caused by pressure changes in middle ear or intracranial cavity. All were unilateral operations. Four patients underwent the repair of the superior semicircular canal dehiscence via transmastoid approach, and the remaining six patients underwent the occlusion of superior semicircular canal via transmastoid approach. One patient was lost to follow-up after surgery. Among nine patients who were followed up for 4-73 months, five patients recovered, three patients got improved, and one patient was invalid. The potential reason for the failure of the operation was that the patient's middle cranial fossa was low, and it was difficult to expose the gap between the dura and the arcuate eminence during the surgery of repair of the superior semicircular canal dehiscence, which resulted in inadequate repair. All patients had no serious postoperative complications such as cerebrospinal fluid leakage or intracranial infection. Conclusion Transmastoid approach for repair of the superior semicircular canal dehiscence and transmastoid approach for the occlusion of superior semicircular canal are both safe and effective for SSCDS. The surgery of the occlusion of superior semicircular canal is more accessible, especially for patients with low middle cranial fossa.