Combined Approach for Tegmen Defects Repair in Patients with Cerebrospinal Fluid Otorrhea or Herniations: Our Experience

Abstract

Objectives To describe our departmental experience in the surgical repair of tegmen tympani defects using a combined transmastoid/minicraniotomic approach.

Design Retrospective review of videos from surgery and patients' charts.

Setting Tertiary university referral center.

Participants Twenty-two patients who underwent surgical repair of tegmen defects associated with cerebrospinal fluid (CSF) leakage and/or meningocele/meningoencephalocele by a combined transmastoid/minicraniotomic approach.

Main Outcome Measures A retrospective review of videos of surgery and charts of patients with tegmen tympani or tegmen antri defects and CSF leakage, temporal lobe encephalocele, and/or meningoencephalocele.

Results All patients underwent the combined approach and had their defects closed, without significant intraoperative or postoperative complications.

Conclusions Mastoidectomy with temporal minicraniotomy represents an effective approach in patients with tegmen tympani dehiscence; the advantages of this technique are the control of the floor of the middle cranial fossa and the possibility to reach bony defects located anteriorly without manipulation of the ossicular chain and temporal lobe.

Keywords

tegmen tympani - middle cranial fossa approach - meningocele - encephalocele - cerebrospinal fluid leakage

• References

• 1 Tóth M, Helling K, Baksa G, Mann W. Localization of congenital tegmen tympani defects. Otol Neurotol 2007; 28 (8) 1120-1123
• 2 Tóth M. Tegmen. In: Tóth M, , ed. Handbook of the Tympanic Cavity. Nagykovácsi, Hungary: Remedium; 2006: 233-242
• 3 Stenzel M, Preuss S, Orloff L, Jecker P, Mann W. Cerebrospinal fluid leaks of temporal bone origin: etiology and management. ORL J Otorhinolaryngol Relat Spec 2005; 67 (1) 51-55
• 4 Stucken EZ, Selesnick SH, Brown KD. The role of obesity in spontaneous temporal bone encephaloceles and CSF leak. Otol Neurotol 2012; 33 (8) 1412-1417
• 5 Connor SEJ. Imaging of skull-base cephalocoeles and cerebrospinal fluid leaks. Clin Radiol 2010; 65 (10) 832-841
• 6 Kutz Jr JW, Husain IA, Isaacson B, Roland PS. Management of spontaneous cerebrospinal fluid otorrhea. Laryngoscope 2008; 118 (12) 2195-2199
• 7 Leonetti JP, Marzo S, Anderson D, Origitano T, Vukas DD. Spontaneous transtemporal CSF leakage: a study of 51 cases. Ear Nose Throat J 2005; 84 (11) 700 , 702–704, 706
• 8 Gacek RR, Gacek MR, Tart R. Adult spontaneous cerebrospinal fluid otorrhea: diagnosis and management. Am J Otol 1999; 20 (6) 770-776
• 9 Markou K, Goudakos J, Franco-Vidal V, Vergnolles V, Vignes JR, Darrouzet V. Spontaneous osteodural defects of the temporal bone: diagnosis and management of 12 cases. Am J Otolaryngol 2011; 32 (2) 135-140
• 10 Oliaei S, Mahboubi H, Djalilian HR. Transmastoid approach to temporal bone cerebrospinal fluid leaks. Am J Otolaryngol 2012; 33 (5) 556-561
• 11 Rao AK, Merenda DM, Wetmore SJ. Diagnosis and management of spontaneous cerebrospinal fluid otorrhea. Otol Neurotol 2005; 26 (6) 1171-1175
• 12 Ramalingam KK, Ramalingam R, SreenivasaMurthy TM, Chandrakala GR. Management of temporal bone meningo-encephalocoele. J Laryngol Otol 2008; 122 (11) 1168-1174
• 13 Sanna M, Fois P, Russo A, Falcioni M. Management of meningoencephalic herniation of the temporal bone: personal experience and literature review. Laryngoscope 2009; 119 (8) 1579-1585
• 14 Semaan MT, Gilpin DA, Hsu DP, Wasman JK, Megerian CA. Transmastoid extradural-intracranial approach for repair of transtemporal meningoencephalocele: a review of 31 consecutive cases. Laryngoscope 2011; 121 (8) 1765-1772
• 15 Pappas DG, Hoffman RA, Holliday RA, Hammerschlag PE, Pappas DG, Swaid SN. Evaluation and management of spontaneous temporal bone cerebrospinal fluid leaks. Skull Base Surg 1995; 5 (1) 1-7
• 16 Kari E, Mattox DE. Transtemporal management of temporal bone encephaloceles and CSF leaks: review of 56 consecutive patients. Acta Otolaryngol 2011; 131 (4) 391-394
• 17 Gubbels SP, Selden NR, Delashaw Jr JB, McMenomey SO. Spontaneous middle fossa encephalocele and cerebrospinal fluid leakage: diagnosis and management. Otol Neurotol 2007; 28 (8) 1131-1139
• 18 Brown NE, Grundfast KM, Jabre A, Megerian CA, O'Malley Jr BW, Rosenberg SI. Diagnosis and management of spontaneous cerebrospinal fluid-middle ear effusion and otorrhea. Laryngoscope 2004; 114 (5) 800-805
• 19 Dutt SN, Mirza S, Irving RM. Middle cranial fossa approach for the repair of spontaneous cerebrospinal fluid otorrhoea using autologous bone pate. Clin Otolaryngol Allied Sci 2001; 26 (2) 117-123
• 20 Glasscock III ME, Dickins JRE, Jackson CG, Wiet RJ, Feenstra L. Surgical management of brain tissue herniation into the middle ear and mastoid. Laryngoscope 1979; 89 (11) 1743-1754
• 21 Gacek RR. Arachnoid granulation cerebrospinal fluid otorrhea. Ann Otol Rhinol Laryngol 1990; 99 (11) 854-862
• 22 Lundy LB, Graham MD, Kartush JM, LaRouere MJ. Temporal bone encephalocele and cerebrospinal fluid leaks. Am J Otol 1996; 17 (3) 461-469
• 23 Prichard CN, Isaacson B, Oghalai JS, Coker NJ, Vrabec JT. Adult spontaneous CSF otorrhea: correlation with radiographic empty sella. Otolaryngol Head Neck Surg 2006; 134 (5) 767-771
• 24 Patel RB, Kwartler JA, Hodosh RM, Baredes S. Spontaneous cerebrospinal fluid leakage and middle ear encephalocele in seven patients. Ear Nose Throat J 2000; 79 (5) 372-373 , 376–378
• 25 Jackson CG, Pappas Jr DG, Manolidis S , et al. Brain herniation into the middle ear and mastoid: concepts in diagnosis and surgical management. Am J Otol 1997; 18 (2) 198-205 ; discussion 205–206
• 26 Mosnier I, Fiky LEL, Shahidi A, Sterkers O. Brain herniation and chronic otitis media: diagnosis and surgical management. Clin Otolaryngol Allied Sci 2000; 25 (5) 385-391
• 27 Nahas Z, Tatlipinar A, Limb CJ, Francis HW. Spontaneous meningoencephalocele of the temporal bone: clinical spectrum and presentation. Arch Otolaryngol Head Neck Surg 2008; 134 (5) 509-518
• 28 Scurry Jr WC, Ort SA, Peterson WM, Sheehan JM, Isaacson JE. Idiopathic temporal bone encephaloceles in the obese patient. Otolaryngol Head Neck Surg 2007; 136 (6) 961-965