Superior Semicircular Canal Dehiscence Repair through Middle Cranial Fossa Craniotomy with 5 Layers Reconstruction: Our Experience and Surgical Technique
Bibliographic record
Abstract
Introduction: Superior semicircular canal dehiscence (SSCD) is a rare condition that has been recently described. SSCD symptoms include vertigo, oscillopsia, autophony, hypersensitivity to bone conducted sounds, and an apparent conductive hearing loss. Patients who present with severe symptoms may require surgical treatment. Transmastoid and middle fossa approaches are the most common surgical approaches. Methods: We are presenting our experience at the Ottawa Hospital (TOH) and University of Ottawa over the last three years in patients who underwent middle cranial fossa craniotomy with multi-layer (5 layers) reconstruction. Also we describe our multidisciplinary surgical approach and modalities which we use to help localize the SSCD intraoperatively. Patients’ demographic data, presenting symptoms, co-morbidities, radiologic imaging, and length of surgery were recorded. All patients had hearing and vestibular tests before surgery and within 3 months after their surgery. Results: Over the past 3 years, 14 surgeries were performed in 11 patients (three patients had bilateral SSCD). The majority of our patients were males (82%). The age range was 32 to 68 years. All surgeries were done by a team of a neurosurgeon and a neuro-otologist. Localization of the SSCD was done with the help of stereotactic guidance. Five layers’ reconstruction (bone graft, bone dust, artificial dura, temporalis fascia & fibrin sealant) was performed on all of our patients. All patients had significant improvement in their symptoms without sensorineural hearing loss. None of our patients developed post-operative hematoma, infection, seizures, cerebrospinal fluid leakage or facial palsy. Patients left the hospital within 1–2 days. Conclusion: Middle cranial fossa craniotomy with multi layers reconstruction of SSCD should be considered as a safe and effective surgical approach in severely symptomatic patients. We demonstrated that this approach has minimal risks especially in regards to sensorineural hearing loss.
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How this classification was reachedexpand
Full frame machine prediction
Teacher imitationNot calibrated prevalence, not ground truth. Human validation pending. The Gemma side is a direct model label for every work in the frame, read from the title-only record. The Codex side is a classifier learned from the 10,348 direct Codex labels and calibrated to design-weighted sample rates; fields without enough sample support carry no Codex call. Candidate is the union of the two sides; consensus is their intersection. These outputs are machine_predicted_unvalidated and are not human labels.
Distilled classifier scores by category (both heads)
| Category | Codex | Gemma |
|---|---|---|
| Metaresearch | 0.001 | 0.001 |
| Meta-epidemiology (narrow) | 0.002 | 0.001 |
| Meta-epidemiology (broad) | 0.001 | 0.002 |
| Bibliometrics | 0.002 | 0.001 |
| Science and technology studies | 0.002 | 0.002 |
| Scholarly communication | 0.001 | 0.002 |
| Open science | 0.001 | 0.002 |
| Research integrity | 0.002 | 0.003 |
| Insufficient payload (model declined to judge) | 0.002 | 0.001 |
Machine scores (provisional)
The two teacher heads of the student model, read on this work. A score orders the frame for review; it never asserts a category, and the validation status ships verbatim with every row.
Baseline scores from an immature model (maturity gate not passed, 7 training rounds). Scores rank; they never assert a category.
score_only:v0-immature-baseline · verbatim from the scoring run: score_only means the number may rank works, and no category label ships from itClassification
machine, unvalidatedMachine predicted; a candidate call from one source (direct Gemma or distilled Codex), not a consensus.
How this classification was reached, model by model and score by score, is at the end of the page under "How this classification was reached".