Fetal Bovine Collagen Grafts for Repair of Tegmen Defects and Encephaloceles via Middle Cranial Fossa Approach

Objectives: To determine whether allogenic materials using fetal bovine collagen that are commercially available (Durepair, DuraMatrix, and DuraGen) provide outcomes and infection rates comparable to autologous grafts.

Design: Retrospective, single-center case series.

Participants: Patients who underwent surgical repair of a tegmen defect associated with ipsilateral cerebrospinal fluid (CSF) otorrhea using a middle cranial fossa approach between 2004 and 2018 at Loyola University Medical Center.

Main Outcome Measures: Resolution of CSF otorrhea, audiologic outcomes, facial nerve outcomes, and complications.

Results: Thirty-seven patients were included in the study, with an average age of 55 years and average body mass index of 35 kg/m². All patients had some degree of hearing loss preoperatively. Repairs were made with combinations of allograft and autograft in 17 patients, allograft only in 15 patients, and autograft only in 5 patients. The CSF otorrhea resolved in all 36/37 patients, and the other patient's otorrhea resolved with a revision surgery. Three patients had significant complications requiring readmission. There was no statistically significant association between repair graft and surgical outcome.

Conclusion: The use of the middle cranial fossa approach coupled with the use of fetal bovine collagen grafts is an effective and viable method to repair lateral skull base defects. This is a treatment modality that affords a cost-effective solution with salutary outcomes and low morbidity.