Assessment of Metabolic Markers and Osteoporosis in 250 Patients with Superior Semicircular Canal Dehiscence Treated With Middle Fossa Craniotomy

Daniel P Kulinich; Ava Kjos; Roan Anderson; Mahlet Mekonnen; Ashley B Zhang; Quinton Gopen; Isaac Yang

doi:10.1016/j.wneu.2022.06.090

Assessment of Metabolic Markers and Osteoporosis in 250 Patients with Superior Semicircular Canal Dehiscence Treated With Middle Fossa Craniotomy

World Neurosurg. 2022 Oct:166:e52-e59. doi: 10.1016/j.wneu.2022.06.090. Epub 2022 Jun 26.

Authors

Daniel P Kulinich¹, Ava Kjos², Roan Anderson², Mahlet Mekonnen², Ashley B Zhang², Quinton Gopen³, Isaac Yang⁴

Affiliations

¹ Department of Neurosurgery, University of California-Los Angeles, Los Angeles, California, USA; David Geffen School of Medicine, University of California-Los Angeles, Los Angeles, California, USA.
² Department of Neurosurgery, University of California-Los Angeles, Los Angeles, California, USA.
³ Department of Neurosurgery, University of California-Los Angeles, Los Angeles, California, USA; Department of Radiation Oncology, University of California-Los Angeles, Los Angeles, California, USA; Department of Head and Neck Surgery, University of California-Los Angeles, Los Angeles, California, USA; Jonsson Comprehensive Cancer Center, University of California-Los Angeles, Los Angeles, California, USA; Los Angeles Biomedical Research Institute, University of California-Los Angeles, Los Angeles, California, USA; Harbor-UCLA Medical Center, University of California-Los Angeles, Los Angeles, California, USA; David Geffen School of Medicine, University of California-Los Angeles, Los Angeles, California, USA.
⁴ Department of Neurosurgery, University of California-Los Angeles, Los Angeles, California, USA; Department of Radiation Oncology, University of California-Los Angeles, Los Angeles, California, USA; Department of Head and Neck Surgery, University of California-Los Angeles, Los Angeles, California, USA; Jonsson Comprehensive Cancer Center, University of California-Los Angeles, Los Angeles, California, USA; Los Angeles Biomedical Research Institute, University of California-Los Angeles, Los Angeles, California, USA; Harbor-UCLA Medical Center, University of California-Los Angeles, Los Angeles, California, USA; David Geffen School of Medicine, University of California-Los Angeles, Los Angeles, California, USA. Electronic address: iyang@mednet.ucla.edu.

PMID: 35760329
DOI: 10.1016/j.wneu.2022.06.090

Abstract

Background: Superior semicircular canal dehiscence (SSCD) is caused by bony defects in the osseous shell of the arcuate eminence separating the labyrinth and the intracranial space. This pathologic third window causes hydroacoustic transmission resulting in debilitating symptoms. We examine the pathophysiologic association between metabolic markers, previous medical history, and SSCD symptoms before and after middle fossa craniotomy (MFC) treatment.

Methods: This study was conducted between March 2011 and September 2020 with patients with SSCD who underwent MFC. We used a Fisher test to compare variables, including bilateral SSCD, second surgery, ear anomaly, osteoporosis, arthritis, vitamin D, and preoperative/postoperative symptoms, and others. Point-biserial correlation analysis was performed to test correlations between continuous variables and categorical variables.

Results: A total of 250 patients with SSCD underwent MFC repair. There was significant postoperative resolution in all symptoms (P < 0.0001). Laboratory 25-hydroxyvitamin D values correlated with preoperative aural fullness (r_pb= 0.29; P = 0.03), and preoperative disequilibrium (r_pb= -0.32; P = 0.02). Serum calcium values correlated with preoperative hearing loss (r_pb= 0.16; P = 0.02). Osteoporosis history (n = 16; 6%) was more prevalent in female patients (P = 0.0001), associated with higher levels of preoperative hearing loss (odds ratio, 4.56; P = 0.02) and higher postoperative hearing loss resolution (odds ratio, 2.89; P = 0.0509).

Conclusions: Certain metabolic markers may predict SSCD presentation before and after surgery. Previous history of osteoporosis, autoimmune conditions, or arthritis may play a role in SSCD pathophysiology and can help predict clinical outcomes. Future evaluation should take metabolic laboratory values and acquire an exact medical history.

Keywords: Calcium; Middle fossa craniotomy; Osteoporosis; SSCD; Vitamin D.

MeSH terms

Arthritis* / complications
Arthritis* / pathology
Arthritis* / surgery
Calcium
Craniotomy / methods
Female
Hearing Loss* / etiology
Humans
Labyrinth Diseases* / complications
Labyrinth Diseases* / surgery
Osteoporosis* / complications
Osteoporosis* / diagnostic imaging
Osteoporosis* / surgery
Retrospective Studies
Semicircular Canal Dehiscence*
Semicircular Canals / surgery
Vitamin D

Substances

Vitamin D
Calcium