Subscribe to RSS
Middle Cranial Fossa Encephalocele and Cerebrospinal Fluid Leakage: Etiology, Approach, Outcomes
11 September 2018
23 March 2019
28 May 2019 (online)
Objective To compare outcome data for surgical approaches in the management of a middle cranial fossa encephalocele or cerebrospinal fluid (CSF) leak and, secondarily, to evaluate the role of obesity and the etiology of the defect.
Setting Quaternary referral center
Participants The study included 73 patients who underwent surgical repair of middle cranial fossa tegmen defects, two of which underwent bilateral repair.
Outcome Measures Demographic characteristics, clinical presentation, etiology, imaging, audiometry, surgical findings, method and material for repair, and postoperative course.
Results Fifty cases were spontaneous in origin, 2 were iatrogenic, and 23 were because of chronic otitis media. Of the 50, 18 underwent middle fossa craniotomy, 29 underwent a transmastoid approach, and 28 underwent a combined approach for repair. A postoperative CSF leak was seen in five patients: one who had undergone a transmastoid approach and four after a combined approach. There was no significant difference between the three approaches and risk of postoperative CSF fistulae. Two of the CSF fistulae resolved after a lumbar drain, and the remaining three patients required revision surgery.
Conclusions Middle cranial fossa tegmen defects are most commonly seen in obese females and are spontaneous in origin. The most common location was the tegmen mastoideum, and these defects were most commonly repaired through the transmastoid approach, with no greater risk of recurrence.
- 1 Ahren C, Thulin CA. Lethal intracranial complications following inflation in treatment of serous otitis media and due to defects in the petrous bone. Acta Otolaryngol 1965; 60: 407-421
- 2 Ferguson BJ, Wilkins RH, Hudson W, Farmer Jr J. Spontaneous CSF otorrhea from tegmen and posterior fossa defects. Laryngoscope 1986; 96 (06) 635-644
- 3 Son HJ, Karkas A, Buchanan P. , et al. Spontaneous cerebrospinal fluid effusion of the temporal bone: repair, audiological outcomes, and obesity. Laryngoscope 2014; 124 (05) 1204-1208
- 4 Nelson RF, Gantz BJ, Hansen MR. The rising incidence of spontaneous cerebrospinal fluid leaks in the United States and the association with obesity and obstructive sleep apnea. Otol Neurotol 2015; 36 (03) 476-480
- 5 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 (08) 1765-1772
- 6 Carlson ML, Copeland III WR, Driscoll CL. , et al. Temporal bone encephalocele and cerebrospinal fluid fistula repair utilizing the middle cranial fossa or combined mastoid-middle cranial fossa approach. J Neurosurg 2013; 119 (05) 1314-1322
- 7 Kim L, Wisely CE, Dodson EE. Transmastoid approach to spontaneous temporal bone cerebrospinal fluid leaks: hearing improvement and success of repair. Otolaryngol Head Neck Surg 2014; 150 (03) 472-478
- 8 Oliaei S, Mahboubi H, Djalilian HR. Transmastoid approach to temporal bone cerebrospinal fluid leaks. Am J Otolaryngol 2012; 33 (05) 556-561
- 9 Gubbels SP, Selden NR, Delashaw Jr JB, McMenomey SO. Spontaneous middle fossa encephalocele and cerebrospinal fluid leakage: diagnosis and management. Otol Neurotol 2007; 28 (08) 1131-1139
- 10 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 (02) 198-205 , discussion 205–206
- 11 Lundy LB, Graham MD, Kartush JM, LaRouere MJ. Temporal bone encephalocele and cerebrospinal fluid leaks. Am J Otol 1996; 17 (03) 461-469
- 12 Stucken EZ, Selesnick SH, Brown KD. The role of obesity in spontaneous temporal bone encephaloceles and CSF leak. Otol Neurotol 2012; 33 (08) 1412-1417
- 13 Kveton JF, Goravalingappa R. Elimination of temporal bone cerebrospinal fluid otorrhea using hydroxyapatite cement. Laryngoscope 2000; 110 (10 Pt 1): 1655-1659