Multiple Labyrinthine-vascular Otic Capsule Dehiscence Treated by Endovascular Approach

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OBJECTIVE: This report presents for the first time a case of triple otic capsule dehiscence (OCD) of the labyrinthine-vascular type, with 2 dehiscences treated simultaneously and effectively by a recently described endovascular approach. STUDY DESIGN: Case report. SETTING: Single otology/neurotology clinic. SUBJECT: A 47-year-old male with triple otic capsule dehiscence (OCD) and associated symptoms. MAIN OUTCOME MEASURES: Improvement in the Tinnitus Handicap Inventory (THI) and Dizziness Handicap Inventory (DHI) scores. RESULTS: The first OCD was located between the internal jugular vein (IJV) and the posterior semicircular canal (SCC), and the second OCD was located between the vestibular aqueduct (VA) and the IJV. The third OCD, situated between the superior SCC and the superior petrosal sinus, remained untreated since it was considered less contributive to the patient's symptoms. The procedure involved (1) stenting of the right jugular vein combined with (2) coiling of a small portion of the vein in contact with the homonymous vestibular aqueduct. Early clinical signs, along with the audio-vestibular assessment, also suggested the diagnosis of right-sided endolymphatic hydrops. The outcome was uneventful, and the long-term follow-up showed promising results as the menieriform-like vertigo attacks disappeared after the procedure. THI and DHI scores were significantly improved. Auditory symptoms, including tinnitus, also progressively improved, especially after the fitting of a hearing aid. CONCLUSIONS: Multiple OCD (not only dehiscence of the superior SCC) should be systematically looked for on high-resolution computed tomography, given that a combined endovascular approach could be carried out in multiple labyrinthine-vascular forms.

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