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
