Multiple Labyrinthine-vascular Otic Capsule Dehiscence Treated by Endovascular Approach

Area of Science:

• Otolaryngology
• Neurosurgery
• Vascular Surgery

Background:

• Otic capsule dehiscence (OCD) can cause debilitating auditory and vestibular symptoms.
• Labyrinthine-vascular type OCD involves abnormal communication between inner ear structures and adjacent blood vessels.
• Multiple OCDs present a complex management challenge.

Purpose of the Study:

• To report the first case of triple otic capsule dehiscence (OCD) of the labyrinthine-vascular type.
• To describe the successful simultaneous endovascular treatment of two OCDs.
• To evaluate the efficacy of a novel endovascular approach for managing associated symptoms.

Main Methods:

• A case report of a 47-year-old male with triple OCD.
• High-resolution computed tomography (HRCT) for diagnosis.
• A combined endovascular approach involving stenting of the internal jugular vein and coiling of a specific venous segment.
• Audio-vestibular assessment and Tinnitus Handicap Inventory (THI) and Dizziness Handicap Inventory (DHI) scoring.

Main Results:

• Two of three identified labyrinthine-vascular OCDs were successfully treated endovascularly.
• The patient reported disappearance of Ménière-like vertigo attacks.
• Significant improvements were observed in THI and DHI scores, with progressive amelioration of tinnitus and auditory symptoms.

Conclusions:

• Multiple otic capsule dehiscences, particularly of the labyrinthine-vascular type, should be actively sought on HRCT imaging.
• A combined endovascular approach offers a viable and effective treatment option for complex, multiple OCDs.
• This technique holds promise for improving quality of life in patients with severe auditory-vestibular dysfunction due to OCD.