Middle Cranial Fossa Approach for Repair of Tegmen Tympani with Autologous Bone Paste for Spontaneous Otorrhea. Case Report and Review of the Literature

The authors presents the case of a 67-year-old patient, morbidly obese, female, who developed spontaneous otorrhea in the right ear. Initially, the patient was managed at an outside facility and underwent a transmastoid approach for persistent CSF leakage. She did well from the surgery, but within 1 to 2 weeks of post-op, she continued to have persistent otorrhea. The patient was referred to the author's office shortly thereafter. A temporal bone CT scan revealed the presence of multiple areas of defects within the bone of the tegmen tympani. Given the persistent CSF leakage, the decision was made to conduct a right-sided middle cranial fossa approach for repair of the defects noted in the tegmen tympani. Prior to the procedure, a lumbar drain was placed to allow for relaxation of the temporal lobe. Once the extradural dissection was completed, multiple defects were noted within the tegmen tympani. A combination of bone dust harvested from the local craniotomy, along with fibrin glue were combined to form an autologous bone paste. This bone paste was layered along the floor of the middle cranial fossa. Once the bony repair was completed, a small portion of dural allograft was layered between the temporal lobe dura and the bone paste. The lumbar drain was removed after the surgery and the patient's otorrhea resolved.

The author presents this technique of repair of the tegmen tympani with utilization of locally harvested bone paste. Several other techniques have been proposed within the literature, and these will be reviewed in the report.

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Artikel online veröffentlicht:
12. Februar 2021