Combined Mastoidectomy and Middle Fossa Craniotomy for Tegmen Defect Repair: Long-Term Outcomes of a Multidisciplinary Approach

Introduction: Defects in the tegmen tympani can result in cerebrospinal fluid leaks with or without encephaloceles, with a variety of etiologies and presenting symptoms. Operative repair typically involves obliteration of meningocele, as well as dural repair and bony defect repair. Several methods have been described with small series of patients and short-term follow-up.

Objectives: We present the largest series to date of tegmen repair and long-term outcomes with up to 12-year follow-up, with descriptive illustration of our method of repair.

Methods: A retrospective review was performed at a single institution to include all patients with tegmen defects who underwent surgical repair with a multidisciplinary team between 2010 and 2022. Demographic factors, presenting symptoms, method of repair, and outcomes were identified.

Results:

Fig. 1

A total of 149 patients with tegmen defects who underwent surgical repair were included in this study. 65% were female, and 35% were male. 11.4% had history of meningitis, and 6.7% had history of trauma. 49% reported hearing loss at presentation, and 68.9% reported otorrhea. All patients underwent a multidisciplinary approach for combined mastoidectomy and middle fossa craniotomy, followed by extradural use of dural onlay under the temporal lobe, along with titanium mesh to repair the middle fossa floor. Mean follow-up time was 4.5 years. Only one patient had a reported postop CSF leak, requiring return to OR for endoscopic repair of additional sphenoid sinus defect to address rhinorrhea after initial postop resolution of initial otorrhea. No patients required postop shunting.

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Conclusions: Combined mastoidectomy and middle fossa craniotomy with dural onlay and titanium mesh can serve as an effective long-term method for surgical repair of tegmen defect.

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Artikel online veröffentlicht:
05. Februar 2024