Surgical Technique for Repair of Tegmen Dehiscence with Encephalocele: A Retrospective Study

Marcelle Altshuler; Rohan Jha; Saksham Gupta; Christopher S. Hong; Kaasinath Balagurunath; Jakob V.E. Gerstl; Yohan Song; Eduardo Corrales; Timothy Smith

doi:10.1055/a-2430-0394

Journal of Neurological Surgery Part B: Skull Base, Table of Contents

J Neurol Surg B Skull Base 2025; 86(06): 652-660
DOI: 10.1055/a-2430-0394

Original Article

Surgical Technique for Repair of Tegmen Dehiscence with Encephalocele: A Retrospective Study

Authors

Marcelle Altshuler

¹Department of Neurosurgery, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts, United States
Rohan Jha

²Harvard Medical School, Boston, Massachusetts, United States
Saksham Gupta

¹Department of Neurosurgery, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts, United States
Christopher S. Hong

¹Department of Neurosurgery, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts, United States
Kaasinath Balagurunath

³Boston University, Boston, Massachusetts, United States
Jakob V.E. Gerstl

¹Department of Neurosurgery, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts, United States
Yohan Song

⁴Department of Otolaryngology, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts, United States
Eduardo Corrales

⁴Department of Otolaryngology, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts, United States
Timothy Smith

¹Department of Neurosurgery, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts, United States

Abstract

Background and Objectives

Tegmen dehiscence with encephalocele presents certain surgical challenges, necessitating innovative approaches to improve patient outcomes and minimize complications. Here we aim to evaluate the safety and efficacy of a novel middle cranial fossa craniotomy technique.

Methods

Nineteen adult patients with radiographically confirmed tegmen dehiscence with encephalocele were included. Patients underwent a middle cranial fossa craniotomy technique for tegmen dehiscence repair, utilizing a split-thickness bone graft, pedicled pericranial flap, and hydroxyapatite for extradural repair and with an inlay graft for the intradural repair. The primary outcome measured was the major perioperative complications or need for revision surgery, while the secondary outcome measured was the resolution or improvement of preoperative symptoms associated with tegmen dehiscence.

Results

Our series encompassed tegmen dehiscence repairs in 19 patients, with an average age at surgery of 51 years (range: 24–82 years). The average follow-up time was 8.80 months (range: 0.43–27.62 months). Patients commonly presented with symptoms such as hearing loss (n = 8), otorrhea (n = 8), fullness or ear pressure (n = 6), dizziness or imbalance (n = 6), or a history of meningitis (n = 4), among others. Postoperatively, symptoms resolved completely in 42% of patients (n = 8) and partially in 58% of patients (n = 11). Notably, no patients required revision surgery or developed new dehiscence in the follow-up period.

Conclusion

Our middle cranial fossa craniotomy technique for tegmen dehiscence with encephalocele repair demonstrated promising postoperative outcomes, with complete or partial symptom resolution in all patients and no major complications. Our findings suggest that this technique is a safe and effective approach for tegmen dehiscence repair.

Keywords

encephalocele - hydroxyapatite - middle fossa craniotomy - novel surgical technique - pedicled pericranial flap - split-thickness bone graft - tegmen dehiscence

Full Text

References

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