Background: Transcranial techniques are considered the gold standard for the majority of intracranial
pathologies. However, the transmastoid approach may serve as an alternative strategy
for their management in selected cases.
Objective: To present a case of a temporal lobe abscess and another one of a middle fossa pneumocephalus,
both successfully managed employing a transmastoid technique.
Methods: We performed a retrospective chart review of a case of a temporal lobe abscess and
another of a pneumocephalus managed successfully using transmastoid approaches. An
operative video for each case is provided (QR code).
Results: The first case was that of a 62-year-old female with right temporal lobe abscess
and otomastoiditis. Abscess evacuation was performed via a transmastoid approach.
A cortical mastoidectomy was performed to skeletonize the tegmen and approximately
1.5cm x 1cm region of mastoid tegmen was unroofed and the dura exposed. An 18 gauge
angiocath was used to pierce dura and approximately 12cc of purulence was aspirated
resulting in successful evacuation and eradication of the mastoid disease. The second
case was in an 87-year-old female with a left middle cranial fossa cystic pneumocephalus
and associated tegmen defect. A transmastoid approach was used to expose the tegmen
and a catheter was then used to evacuate the pneumocephalus followed by transmastoid
dura and tegmen defect repair. No complications resulted for either of the cases.
Conclusion: The transmastoid approach provides a minimally invasive and direct alternative to
the tegmen and middle cranial disease and can be used in selected cases, allowing
for management of complex intracranial disease in a single stage.
