Background: Superior semicircular canal dehiscence (SSCD) is a recently described rare condition. SSCD symptoms include vertigo, oscillopsia, autophony, sound hypersensitivity , and conductive hearing loss. Patients with sever symptoms may require surgical treatment. Tranmastoid and middle fossa (MCF) approaches are common approaches. Methods: We are presenting our experience at the Ottawa Hospital over the last three years. Also we describe our multidisciplinary surgical approach and modalities to localize the SSCD intraoperatively. Demographic data, presenting symptoms, co-morbidities, radiologic imaging, and surgery length were recorded. All patients had hearing and vestibular tests before and after their surgeries. Results: 14 surgeries were performed in 11 patients (three patients had bilateral SSCD). Most patients were males (82%). Age range was 32-68 years. Surgeries were done by a team of a neurosurgeon and a neuro-otologist. Localization of SSCD was done using stereotactic guidance. Five layers’ reconstruction was performed in all patients. All patients had significant improvement in symptoms without sensorineural hearing loss. None of the patients developed post-operative hematoma, infection, seizures, CSF leakage or facial palsy. LOS was 1-2 days. Conclusions: MCF with multi layers reconstruction should be considered as a safe and effective approach in severely symptomatic patients. We demonstrated that this approach has minimal risks especially in regards to sensorineural hearing loss.