Transmastoid Approach as an Alternative for the Management of Intracranial Pathology: Report of Two Cases

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.

No conflict of interest has been declared by the author(s).

Publication History

Article published online:
05 February 2024