Medical Student University of Pittsburgh School of Medicine Sugar Land, Texas, United States
Introduction: Tegmen tympani defects associated with encephaloceles and cerebrospinal fluid (CSF) leakage may be spontaneous or due to other known causes. The management of spontaneous defects via an intradural approach is not well published in neurosurgical journals as most studies describe extradural middle fossa and/or trans-mastoid approaches to repair. Here we describe spontaneous tegmen tympani defects with encephaloceles repaired via an intradural sub-temporal middle fossa approach.
Methods: This study is a retrospective case series of all patients with spontaneous tegmen tympani defects with encephaloceles encountered in a single-surgeon neurosurgical private practice over an eight-year period. All patients underwent an intradural sub-temporal middle fossa craniotomy for repair. We describe presenting symptoms, intraoperative findings, clinical improvement, and complications over a 5-month median follow-up period.
Results: A total of nine patients were included. All patients initially presented with conductive hearing loss and CSF rhinorrhea, four patients presented with CSF otorrhea after tympanostomy tube placement, and five patients also complained of headaches and balance disturbance. Three patients had prior extradural and/or trans-mastoid operations at other institutions which were either unsuccessful or resulted in reoccurrence. Intraoperatively, all patients were found to have encephaloceles, and three patients (33%) were found to have multiple defects in the dura and tegmen tympani. All patients had complete resolution of presenting symptoms, including resolution of CSF leak and improvement in hearing. There were no complications encountered.
Conclusion : An intradural sub-temporal middle fossa approach for treatment of spontaneous tegmen tympani defects with encephaloceles is a viable alternative to other surgical approaches. An intradural approach allows for better visualization and repair of defects, especially in cases of multiple defects, as well as easier management of the encephalocele. In this case series, an intradural approach resulted in complete resolution of CSF leakage and clinical improvement in all patients with no complications.
