Middle Fossa Repair of Superior Semicircular Canal Dehiscence Using a Multilayer Reconstruction Technique: Surgical Video.

Introduction: Superior semicircular canal dehiscence syndrome (SSCDS) is an uncommon otologic disorder caused by a defect of the bony covering of the superior semicircular canal, producing a pathological “third-window” phenomenon. This abnormal communication between the inner ear and middle cranial fossa may result in a wide spectrum of vestibular and auditory symptoms, including sound- and pressure-induced vertigo, autophony, tinnitus, hyperacusis, and oscillopsia. In symptomatic patients with significant functional impairment, surgical repair of the dehiscence can provide substantial improvement in quality of life. The middle cranial fossa approach remains one of the most effective techniques because it allows direct visualization of the superior semicircular canal and precise reconstruction of the defect. We present the surgical technique and early clinical outcome of middle fossa resurfacing for SSCDS. Case Report: A 51-year-old man presented with debilitating vestibular and auditory symptoms, including autophony, dizziness, vertigo, Tullio phenomenon, pulse-synchronous oscillopsia, hyperacusis, left aural fullness, pulsatile tinnitus, tinnitus, fatigue, and migraine-like headaches. The symptoms significantly affected daily activities and quality of life. High-resolution computed tomography of the temporal bone demonstrated a left superior semicircular canal dehiscence, confirming the anatomical defect responsible for the clinical presentation. Due to the severity of symptoms and their substantial impact on the patient’s functional status, surgical treatment was indicated. A temporal craniotomy was performed through a middle cranial fossa approach. After careful extradural elevation of the temporal lobe dura, the arcuate eminence was identified as an anatomical landmark, allowing precise localization of the superior semicircular canal and direct visualization of the dehiscent segment. The bony defect was meticulously exposed and repaired using a multilayer reconstruction technique.The dehiscence was initially reinforced with bone wax to achieve adequate sealing of the abnormal communication, followed by placement of autologous fascia and reinforcement with fibrin sealant. A muscle graft was subsequently applied to provide additional structural support and contribute to a durable watertight reconstruction. This multilayer strategy aimed to restore the normal anatomical barrier of the superior semicircular canal while minimizing the risk of persistent third-window symptoms or postoperative cerebrospinal fluid leakage. Results: The patient experienced immediate postoperative improvement of the disabling vestibular and auditory symptoms. No new neurological deficits, facial nerve dysfunction, or deterioration of hearing were observed during early follow-up. The rapid resolution of symptoms confirmed the effectiveness of the surgical reconstruction. Conclusion: The middle cranial fossa approach provides excellent exposure of the superior semicircular canal and allows direct identification and secure reconstruction of the dehiscence. In carefully selected patients with incapacitating SSCDS, multilayer resurfacing using autologous materials and biological reinforcement offers a safe and effective treatment strategy. This technique enables precise anatomical repair, rapid symptom improvement, and favorable functional outcomes while preserving neurological and auditory function.