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J Neurol Surg B Skull Base
DOI: 10.1055/a-2430-0273
Original Article

Intradural Repair of Temporal Bone Encephalocele and Cerebrospinal Fluid Leak: Results from a Single Institution

Susan E. Ellsperman
1   House Ear Institute, Otology/Neurotology Los Angeles, California, United States
,
Anna K. D'Agostino
1   House Ear Institute, Otology/Neurotology Los Angeles, California, United States
2   Campbell University Jerry M. Wallace School of Osteopathic Medicine, Buies Creek, North Carolina, United States
,
Adam M. Olszewski
3   Department of Neurosurgery, Mercy Hospital Springfield Area, Springfield, Missouri, United States
,
Kevin A. Peng
1   House Ear Institute, Otology/Neurotology Los Angeles, California, United States
,
William H. Slattery
1   House Ear Institute, Otology/Neurotology Los Angeles, California, United States
,
Gregory P. Lekovic
4   Department of Neurosurgery, UCLA Medical School, Los Angeles, California, United States
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Abstract

Background Lateral temporal bone encephaloceles incidence is increasing with obesity rates. Middle fossa (MF) craniotomy, transmastoid (TM), or combined MF + TM access can be used for repair.

Methods Retrospective review of MF or MF + TM repair with an intradural graft. Sex, age, and body mass index (BMI) were collected. Pre/postoperative audiometric results were included. Postoperative complications were reported.

Results A total of 49 patients (50 repairs) were included. In addition, 74% were women (p < 0.05). Ten patients had a history of chronic otitis media and surgery. Average BMI was 35.8, and average age was 59. Furthermore, 54% had multiple skull base defects; 18 (36%) patients had a MF approach. In total, 32 (64%) patients had a MF + TM approach for repair; 13 (40.1%) of these patients had a concurrent tympanoplasty. Hearing improved for 74%. Air conduction pure-tone average improved by an average of 5 dB (p 0.27). No differences in hearing outcomes were observed between the MF and MF + TM groups. Two patients (6%) had hearing decline. Eight complications were reported (1 (2%) skin infection, 4 (8%) recurrent/persistent cerebrospinal fluid [CSF] leaks requiring lumbar drain or shunt, and 3 (6%) episodes of aphasia or mental status change). Age >65 years was not associated with risk of postoperative complication.

Conclusion Intradural repair of encephalocele and CSF leak is a safe and effective surgical approach. Intradural reinforcement along the entire MF floor is beneficial for multiple areas of dehiscence and thin dura. Complication rates including recurrent/persistent CSF leak and aphasia related to temporal lobe retraction were similar to previously published reports and not associated with older patient age. Hearing was stable or improved in 94% with no difference noted between MF and MF + TM repair.

Keywords

encephalocele - CSF leaks - hearing outcomes - lateral skull base - intradural repair


Publication History

Received: 19 July 2024

Accepted: 27 September 2024

Accepted Manuscript online:
01 October 2024

Article published online:
24 October 2024

© 2024. Thieme. All rights reserved.

Georg Thieme Verlag KG
Rüdigerstraße 14, 70469 Stuttgart, Germany

 

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