Temporal Craniotomy for Management of Middle Cranial Fossa Encephaloceles with CSF Leaks

Introduction: Temporal encephaloceles are pathological herniations of brain parenchyma through congenital or acquired osseus-dural defects of the middle cranial fossa. Both open procedures and endoscopic techniques have been advocated for the treatment of such conditions. We describe the midterm follow-up of patients with spontaneous, iatrogenic, and traumatic temporal bone encephaloceles treated by temporal craniotomy and determine the effectiveness and safety of this procedure.

Methods: We conducted a retrospective review of six patients undergoing surgical repair of temporal encephalocele between March 2011 and June 2012. The patients’ files and imaging studies were evaluated. All lesions were repaired through a small temporal craniotomy, extradural identification of middle fossa elements, and the osseus-dural defects and sealing of the defect with soft tissue with or without a bone graft.

Results: There were five females and one male in our series, with mean age of 51.3 years (range, 8-88 years). The most common presenting sign was otorrhea (66%). Of the six consecutive cases, four patients had a temporal encephalocele without any history of temporal bone surgery or trauma. Two patients had previous failed surgical procedures for the temporal lesion. There were no mortality and no long-term complications. Hearing preservation was achieved in all cases. All CSF leaks were successfully repaired. One patient sustained a transient immediate postoperative otorrhea that was resolved after a few days of lumbar drainage.

Conclusion: Temporal encephalocele can be safely repaired through a temporal craniotomy approach, performed by a team of neurosurgeons and ENT surgeons. A high percentage of complete resolution and satisfying hearing outcome with a low complication rate is achieved using this technique.