Surgical management of middle cranial fossa bone defects: meningoencephalic herniation and cerebrospinal fluid leaks

• Published in: American journal of otolaryngology Vol. 41; no. 4; p. 102560
• Main Authors: Hernandez-Montero, Elena, Caballero, Erika, García-Ibanez, Luis
• Format: Journal Article
• Language: English
• Published: Maryland Heights Elsevier Inc 01.07.2020; Elsevier Limited
• Subjects: Body mass index; Cartilage; Cerebrospinal fluid; Cerebrospinal fluid (CSF) leak; Congenital diseases; Defects; Ear; Ear canal; Ear diseases; Ears & hearing; Etiology; Hearing loss; Hypertension; Ischemia; Literature reviews; Meningitis; Meningoencephalic herniation; Middle cranial Fossa; Middle ear; Obesity; Otitis media; Otology; Patients; Skull; Surgery; Temporal bone; Temporal bone defect; MCF; MEH; COM/Ch; Middle cranial Fossa; Meningoencephalic herniation; CSF; Temporal bone defect; TM; Cerebrospinal fluid (CSF) leak
• ISSN: 0196-0709; 1532-818X
• DOI: 10.1016/j.amjoto.2020.102560

Along the medical practice of an Otologist he/she will face middle cranial fossa (MCF) bone defects. The purpose of this study is to contribute to the understanding of this possible life threatening condition, and to share and discuss our management approach. A literature review is also presented. Retrospective case series at García-Ibáñez Otology and Skull base private center referral. METHODS: This study is based on the analysis of data collected from 19 cases of temporal bone meningoencephalic herniations surgically treated from 2006 to 2018. The follow-up ranged from 18 to 162 months with a mean average of 44.5 months. Meningoencephalic herniations were divided into four etiologic groups: spontaneous (24.8%), secondary to chronic otitis media (21.8%), iatrogenic (45.9%), and posttraumatic (7.5%). Different surgical techniques were used as treatment: transmastoid (TM) approach (27.8%), MCF approach (27.8%), combined technique (transmastoid plus minicraniotomy, 3%), and middle ear obliteration with blind sac closure of the external auditory canal (41.4%). Variables like bilateral hearing level, size and location of the bone defect and existence of CSF leak should be analyzed to select the safest and most effective closing surgical approach.