Partitioning the Labyrinth: Indications for Transmastoid Semicircular Canal Occlusion

Conference paper


In this chapter, I have presented three relatively novel and unique indications for mastoidectomy with semicircular canal occlusion – benign paroxysmal positional vertigo, superior semicircular canal dehiscence syndrome, and petroclival tumours and vascular anomalies. For the former two indications, the likelihood of surgical success is extremely high, between 94 and 100 % in terms of marked to full resolution of symptoms, with significant loss of hearing distinctly uncommon. For petroclival tumours, once believed to be inoperable, resection rates approximate 50 %, with most patients able to maintain functional hearing, and as few as one in five sustaining long-term facial nerve injury.


Semicircular Canal Benign Paroxysmal Positional Vertigo Vestibular Evoke Myogenic Potential Hearing Preservation Pulsatile Tinnitus 
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Reference List

  1. Agrawal SK, Parnes LS (2001) Human experience with canal plugging. Ann N Y Acad Sci 942:300–305PubMedCrossRefGoogle Scholar
  2. Agrawal SK, Parnes LS (2008) Transmastoid superior semicircular canal occlusion. Otol Neurotol 29(3):363–367PubMedCrossRefGoogle Scholar
  3. Ahmed RM, Pohl DV, MacDougall HG, Makeham T, Halmagyi GM (2012) Posterior semicircular canal occlusion for intractable benign positional vertigo: outcome in 55 ears in 53 patients operated upon over 20 years. J Laryngol Otol 126(7):677–682PubMedCrossRefGoogle Scholar
  4. Amoodi HA, Makki FM, McNeil M, Bance M (2011) Transmastoid resurfacing of superior semicircular canal dehiscence. Laryngoscope 121(5):1117–1123PubMedCrossRefGoogle Scholar
  5. Arriaga M, Gorum M (1996) Enhanced retrosigmoid exposure with posterior semicircular canal resection. Otolaryngol Head Neck Surg 115:46–48PubMedCrossRefGoogle Scholar
  6. Bambakidis N, Kataria U, Kim L et al (2007) Evolution of surgical approaches in the treatment of petroclival meningiomas: a retrospective review. Neurosurgery 61(2):202–209PubMedCrossRefGoogle Scholar
  7. Behari S, Tyagi I, Banerji D, Kumar V, Jaiswal AK (2010) Postauricular, transpetrous, presigmoid approach for extensive skull base tumors in the petroclival region: the successes and the travails. Acta Neurochir (Wien) 152(10):1633–1645CrossRefGoogle Scholar
  8. Bennett M, Warren F, Haynes D (2006) Indications and technique in mastoidectomy Otolaryngol. Clin North Am 39(6):1095–1113Google Scholar
  9. Beyea JA, Agrawal SK, Parnes LS (2012) Transmastoid semicircular canal occlusion: a safe and highly effective treatment for benign paroxysmal positional vertigo and superior canal dehiscence. Laryngoscope 122(8):1862–1866PubMedCrossRefGoogle Scholar
  10. Brandt MG, Poirier J, Hughes B, Lownie SP, Parnes LS (2010) The transcrusal approach: a 10-year experience at one Canadian center. Neurosurgery 66(5):1017–1022PubMedCrossRefGoogle Scholar
  11. Brantberg K, Bergenius J, Mendel L, Witt H, Tribukait A, Ygge J (2001) Symptoms, findings and treatment in patients with dehiscence of the superior semicircular canal. Acta Otolaryngol 121(1):68–75PubMedCrossRefGoogle Scholar
  12. Carey JP (2007) Semicircular canal function before and after surgery for superior canal dehiscence. Otol Neurotol 18(3):356–364CrossRefGoogle Scholar
  13. Chanda A, Nanda A (2002) Partial labyrinthectomy petrous apicectomy approach to the petroclival region: an anatomic and technical study. Neurosurgery 51(1):147–159PubMedCrossRefGoogle Scholar
  14. Couldwell WT, Fukushima T, Giannotta SL, Weiss MH (1996) Petroclival meningiomas: surgical experience in 109 cases. J Neurosurg 84(1):20–28PubMedCrossRefGoogle Scholar
  15. Das-Purkayastha PK, Coulson CJ, Pothier DD, Lai P, Rutka JA (2012) Time trend analysis of mastoidectomy procedures performed in Ontario, 1987–2007. Acta Otolaryngol 132(1):16–20PubMedCrossRefGoogle Scholar
  16. Deschenes GR, Hsu D, Megerian CA (2009) Outpatient repair of superior semicircular canal dehiscence via the transmastoid approach. Laryngoscope 119(9):1765–1769PubMedCrossRefGoogle Scholar
  17. Dingle AF, Hawthorne MR, Kumar BU (1992) Fenestration and occlusion of the posterior semicircular canal for benign positional vertigo. Clin Otolaryngol Allied Sci 17(4):300–302PubMedCrossRefGoogle Scholar
  18. Epley JM (1980) Singular neurectomy: hypotympanotomy approach. Otolaryngol Head Neck Surg 88(3):304–349PubMedGoogle Scholar
  19. Fiorino F, Barbieri F, Pizzini FB, Beltramello A (2010) A dehiscent superior semicircular canal may be plugged and resurfaced via the transmastoid route. Otol Neurotol 31(1):136–139PubMedCrossRefGoogle Scholar
  20. French LC (2008) An estimate of the number of mastoidectomy procedures performed annually in the United States. Ear Nose Throat J 87(5):267–270PubMedGoogle Scholar
  21. Gacek RR (1974) Transection of the posterior ampullary nerve for the relief of benign paroxysmal positional vertigo. Ann Otol Rhinol Laryngol 83(5):596–605PubMedGoogle Scholar
  22. Gacek RR (1984) Cupulolithiasis and posterior ampullary nerve transection. Ann Otol Rhinol Laryngol Suppl 112:25–30PubMedGoogle Scholar
  23. Hawthorne M, el-Naggar M (1994) Fenestration and occlusion of posterior semicircular canal for patients with intractable benign paroxysmal positional vertigo. J Laryngol Otol 108(11935):939Google Scholar
  24. Helminski JO, Zee DS, Janssen I, Hain TC (2010) Effectiveness of particle repositioning maneuvers in the treatment of benign paroxysmal positional vertigo: a systematic review. Phys Ther 90(5):663–678PubMedCrossRefGoogle Scholar
  25. Hillman TA, Kertesz TR, Hadley K, Shelton C (2006) Reversible peripheral vestibulopathy: the treatment of superior canal dehiscence. Otolaryngol Head Neck Surg 134(3):431–436PubMedCrossRefGoogle Scholar
  26. Hirsch BE, Cass SP (1993) Translabyrinthine approach to skull base tumors with hearing preservation. Am J Otol 14(6):533–543PubMedGoogle Scholar
  27. Horgan MA, Anderson GJ, Kellogg JX, Schwartz MS, Spektor S, McMenomey SO, Delashaw JB (2000) Classification and quantification of the petrosal approach to the petroclival region. J Neurosurg 93(1):108–112PubMedCrossRefGoogle Scholar
  28. Horgan MA, Delashaw JB, Schwartz MS, Kellogg JX, Spektor S, McMenomey SO (2001) Transcrusal approach to the petroclival region with hearing preservation. Technical note and illustrative cases. J Neurosurg 94(4):660–666PubMedCrossRefGoogle Scholar
  29. House JW, Brackmann DE (1985) Facial nerve grading system. Otolaryngol Head Neck Surg 93:146–147PubMedGoogle Scholar
  30. Kartush JM, Sargent EW (1995) Posterior semicircular canal occlusion for benign paroxysmal positional vertigo-CO2-laser-assisted technique: preliminary results. Laryngoscope 105(3 Part 1):268–274PubMedCrossRefGoogle Scholar
  31. Kaylie DM, Horgan MA, Delashaw JB, McMenomey SO (2004) Hearing preservation with the transcrusal approach to the petroclival region. Otol Neurotol 25(4):594–598PubMedCrossRefGoogle Scholar
  32. Kirtane AV, Sharma A, Satwalekar D (2009) Transmastoid repair of superior semicircular canal dehiscence. J Laryngol Otol 123(3):356–358PubMedCrossRefGoogle Scholar
  33. Kisilevsky V, Bailie NA (2009) Lessons learned from the surgical management of benign paroxysmal positional vertigo: the University Health Network experience with posterior semicircular canal occlusion surgery (1988–2006). J Otolaryngol Head Neck Surg 38(2):212–221PubMedGoogle Scholar
  34. Limb CJ, Carey JP, Srireddy S, Minor LB (2006) Auditory function in patients with surgically treated superior semicircular canal dehiscence. Otol Neurotol 27(7):969–980PubMedCrossRefGoogle Scholar
  35. Lin SZ, Fan JP, Sun AH, Guan J, Liu HB, Zhu QB (2010) Efficacy of laser occlusion of posterior semicircular canal for benign paroxysmal positional vertigo: case report. J Laryngol Otol 124(5):e5PubMedCrossRefGoogle Scholar
  36. Little KM, Friedman AH, Sampson JH, Wanibuchi M, Fukushima T (2005) Surgical management of petroclival meningiomas: defining resection goals based on risk of neurological morbidity and tumor recurrence rates in 137 patients. Neurosurgery 56(3):546–559PubMedCrossRefGoogle Scholar
  37. Magliulo G, Parrotto D, Cuiuli G, Alla FR, Gagliardi M (2007a) Preservation of vestibular evoked myogenic potentials with modified translabyrinthine approach. Arch Otolaryngol Head Neck Surg 133(7):720–723CrossRefGoogle Scholar
  38. Magliulo G, Parrotto D, Stasolla A, Marini M (2004) Modified translabyrinthine approach and hearing preservation. Laryngoscope 114(6):1133–1138PubMedCrossRefGoogle Scholar
  39. Magliulo G, Stasolla A, Parrotto D, Marini M (2007b) Modified translabyrinthine approach and hearing preservation: imaging evaluation. J Laryngol Otol 121(8):736–741CrossRefGoogle Scholar
  40. McAskile K (1980) The radical mastoidectomy. J Otolaryngol 9(2):143–148PubMedGoogle Scholar
  41. McElveen JT Jr, Wilkins RH, Molter DW (1993) Hearing preservation using the modified translabyrinthine approach. Otolaryngol Head Neck Surg 108(6):671–679PubMedGoogle Scholar
  42. Meyerhoff WL (1985) Surgical section of the posterior ampullary nerve. Laryngoscope 95(8):933–935PubMedCrossRefGoogle Scholar
  43. Mikulec AA, Poe DS, McKenna MJ (2005) Operative management of superior semicircular canal dehiscence. Laryngoscope 115(3):501–507PubMedCrossRefGoogle Scholar
  44. Milstein S (1980) The history of mastoid surgery. Am J Otol 1(3):174–178PubMedGoogle Scholar
  45. Minor LB (2000) Superior canal dehiscence syndrome. Am J Otol 21(1):9–19PubMedCrossRefGoogle Scholar
  46. Minor LB (2005) Clinical manifestations of superior semicircular canal dehiscence. Laryngoscope 115(10):1717–1727PubMedCrossRefGoogle Scholar
  47. Minor LB, Cremer PD, Carey JP, Della Santina CC, Streubel SO, Weg N (2001) Symptoms and signs in superior canal dehiscence syndrome. Ann N Y Acad Sci 942:259–273PubMedCrossRefGoogle Scholar
  48. Minor LB, Solomon D, Zinreich JS, Zee DS (1998) Sound- and/or pressure-induced vertigo due to bone dehiscence of the superior semicircular canal. Arch Otolaryngol Head Neck Surg 124(3):249–258PubMedCrossRefGoogle Scholar
  49. Molony TB, Kwartler A, House JW, Hitselberger WE (1992) Extended middle fossa and retrolabyrinthine approaches in acoustic neuroma surgery: case reports. Am J Otol 13:360–363PubMedGoogle Scholar
  50. Oghalai JS, Buxbaum JL, Jackler RR, McDermott MW (2005) Skull base chondrosarcoma originating from the petroclival junction. Otol Neurotol 26(5):1052–1060PubMedCrossRefGoogle Scholar
  51. Pace-Balzan A, Rutka JA (1991) Non-ampullary plugging of the posterior semicircular canal for benign paroxysmal positional vertigo. J Laryngol Otol 105(11):901–996PubMedCrossRefGoogle Scholar
  52. Parnes LS, Agrawal SK, Atlas J (2003) Diagnosis and management of benign paroxysmal positional vertigo (BPPV). CMAJ 169(7):681–693PubMedPubMedCentralGoogle Scholar
  53. Parnes LS, McClure JA (1985) Effect on brainstem auditory evoked responses of posterior semicircular canal occlusion in guinea pigs. J Otolaryngol 14(3):145–150PubMedGoogle Scholar
  54. Parnes LS, McClure JA (1990) Posterior semicircular canal occlusion for intractable benign paroxysmal positional vertigo. Ann Otol Rhinol Laryngol 99(5 Pt 1):330–334PubMedGoogle Scholar
  55. Parnes LS, McClure JA (1991) Posterior semicircular canal occlusion in the normal hearing ear. Otolaryngol Head Neck Surg 104(1):52–57PubMedGoogle Scholar
  56. Petit JL (1774) Traite des maladies chirurgicals Didot. ParisGoogle Scholar
  57. Ramakrishna J, Goebel JA, Parnes LS (2012) Efficacy and safety of bilateral posterior canal occlusion in patients with refractory benign paroxysmal positional vertigo: case report series. Otol Neurotol 33(4):640–642PubMedCrossRefGoogle Scholar
  58. Roberti F, Sekhar LN, Kalavakonda C, Wright DC (2001) Posterior fossa meningiomas: surgical experience in 161 cases. Surg Neurol 56(1):8–20PubMedCrossRefGoogle Scholar
  59. Seifert V (2010) Clinical management of petroclival meningiomas and the eternal quest for preservation of quality of life: personal experiences over a period of 20 years. Acta Neurochir (Wien) 152(7):1099–1116CrossRefGoogle Scholar
  60. Sekhar LN, Schessel DA, Bucur SD, Raso JL, Wright DC (1999) Partial labyrinthectomy petrous apicectomy approach to neoplastic and vascular lesions of the petroclival area. Neurosurgery 44(3):537–550 (discussion:550-2)PubMedCrossRefGoogle Scholar
  61. Shah SB, Jackler RK (1998) Facial nerve surgery in the 19th and early 20th centuries: The evolution from crossover anastomosis to direct nerve repair. Am J Otol 19(2):236–245PubMedGoogle Scholar
  62. Shaia WT, Zappia JJ, Bojrab DI, LaRouere ML, Sargent EW, Diaz RC (2006) Success of posterior semicircular canal occlusion and application of the dizziness handicap inventory. Otolaryngol Head Neck Surg 134(3):424–430PubMedCrossRefGoogle Scholar
  63. Sincoff EH, McMenomey SO, Delashaw JB Jr (2007) Posterior transpetrosal approach: less is more. Neurosurgery 6(2 Suppl 1):ONS-53–ONS-58Google Scholar
  64. Siwanuwatn R, Deshmukh P, Figueiredo EG et al (2006) Quantitative analysis of the working area and angle of attack for the retrosigmoid, combine petrosal, and transcochlear approaches to the petroclival region. J Neurosurg 104:137–142PubMedCrossRefGoogle Scholar
  65. Smouha EE, Inouye M (1999) Partial labyrinthectomy with hearing preservation: frequency-specific data using tone-burst auditory brain stem response. Otolaryngol Head Neck Surg 120(2):146–152PubMedCrossRefGoogle Scholar
  66. Springborg LK, Springborg JB, Thomsen J (2007) Hearing preservation after classical translabyrinthine removal of a vestibular schwannoma: case report and literature review. J Laryngol Otol 121(1):76–79PubMedCrossRefGoogle Scholar
  67. Tahara A, de Santana PA Jr, Calfat Maldaun MV, Panagopoulos AT, da Silva AN (2009) Petroclival meningiomas: surgical management and common complications. J Clin Neurosci 16(5):655–659PubMedCrossRefGoogle Scholar
  68. Takami T, Ohata K, Goto T, Tsuyuguchi N, Nishio A, Hara M (2006) Surgical management of petroclival chordomas: report of eight cases. Skull Base 16(2):85–94PubMedCrossRefPubMedCentralGoogle Scholar
  69. Taplin MA, Anthony R, Tymianski M (2006) Transmastoid partial labyrinthectomy for brainstem vascular lesions: clinical outcomes and assessment of postoperative cochleovestibular function. Skull Base 16(3):133–143PubMedCrossRefPubMedCentralGoogle Scholar
  70. Teixido MT, Artz GJ, Kung BC (2008) Clinical experience with symptomatic superior canal dehiscence in a single neurotologic practice. Otolaryngol Head Neck Surg 139(3):405–413PubMedCrossRefGoogle Scholar
  71. Tringali S, Bertholon P, Chelikh L, Jacquet C, Prades JM, Martin C (2004) Hearing preservation after modified translabyrinthine approach performed to remove a vestibular schwannoma. Ann Otol Rhinol Laryngol 113(2):152–155PubMedGoogle Scholar
  72. Tullio P (1929) Das Ohr und die Entstehung der Sprache und Schrift. Urban & Schwarzenberg, BerlinGoogle Scholar
  73. Vlastarakos PV, Proikas K, Tavoulari E, Kikidis D, Maragoudakis P, Nikolopoulos TP (2009) Efficacy assessment and complications of surgical management for superior semicircular canal dehiscence: a meta-analysis of published interventional studies. Eur Arch Otorhinolaryngol 266(2):177–186PubMedCrossRefGoogle Scholar
  74. Walsh RM, Bath AP (1999) Long-term results of posterior semicircular canal occlusion for intractable benign paroxysmal positional vertigo. Clin Otolaryngol Allied Sci 24(4):316–323PubMedCrossRefGoogle Scholar
  75. Walsh RM, Tymianski M, Wallace MC, Bath AP (2000) The transmastoid partial labyrinthectomy approach to medial skull base lesions. Rev Laryngol Otol Rhinol (Bord) 121(1):13–20Google Scholar
  76. Welling DB, Parnes LS, O’Brien B, Bakaletz LO, Brackmann DE, Hinojosa R (1997) Particulate matter in the posterior semicircular canal. Laryngoscope 107(1):90–94PubMedCrossRefGoogle Scholar
  77. Zappia JJ (1996) Posterior semicircular canal occlusion for benign paroxysmal positional vertigo. Am J Otol 17(5):749–754PubMedGoogle Scholar

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© Springer-Verlag Wien 2014

Authors and Affiliations

  1. 1.London Health Sciences Centre, University HospitalSchulich School of Medicine & Dentistry, Western UniversityLondon, Ontario N6A 5A5Canada

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