New classification of superior semicircular canal dehiscence in HRCT

Background and purpose: The complex anatomy of the temporal bone is difficult to understand and constitutes a challenge in the daily diagnostic routine even for experienced neuroradiologists. In the context of otoneurological (oVEMP) and preoperative diagnostics, the diagnosis of superior semicircular canal dehiscence (SSCD) is of great importance for Ear, Nose, and Throat (ENT) specialists. The gold standard for this diagnosis is a high-resolution CT (HRCT) of the temporal bone. In order to correctly diagnose SSCD, special oblique reconstructions are necessary in addition to standard (axial, coronal, sagittal) reconstructions. We evaluated the frequency of diagnosis and its location in HRCT in correlation with otoneurological examination. From this analysis, we present a new SSCD classification. This classification yields the potential of a differentiated analysis of the patient’s clinical symptoms with correlation to the cross-sectional anatomy and may lead to a differentiated therapy approach. Study design and setting: We evaluated 1370 temporal bone scans of patients with residual hearing and verified 343 superior semicircular canal dehiscence (SSCD). We conducted a subgroup analysis of these 343 HRCT scans displaying a SSCD and used them as a basis to create a classification. Results: Three location types of SSCD were identified. These were anterior type 1, superior type 2 and posterior type 3. Type 2 were significantly more frequent in both sexes. SSCD at this location can be overlooked if diagnosis is performed only in the standard axial plane, since it can only be visualized by means of double oblique reconstruction. We present a standardized reconstruction algorithm. Conclusion: In total, three types of SSCD with differing incidences can be extrapolated from the locations. Superior type 2 is the most frequent one. Both sexes are affected with roughly equal incidence. The use of standardized double oblique reconstruction algorithm ensures that all three types are diagnosed in the HRCT.