Repair of Temporal Bone Defects via the Middle Cranial Fossa Approach: Treatment of 2 Pathologies With 1 Operation

Abstract

TBD may present with symptoms of CSF leak/encephalocele, but may also present with superior SCD. We recommend consistent review of the temporal bone imaging to check for superior SCD, and repair of the SCD first to prevent complications involving the labyrinth and cochlea. MCF approach using a multilayer repair without a lumbar drain is highly effective with minimal risk of complications.

Surgical management of spontaneous temporal bone cerebrospinal fluid leaks: Results of a strategy based on defect location. A bicentric retrospective study of 44 cases

“…The results obtained in a bicentric setting with this strategy (96% success rate at first attempt) are comparable to those of other authors using only transmastoid approach (80 to 93%) or MCF approach (95 to 100%), with a very low rate of complications.…”

“…Some authors advocate a transmastoid approach, while others recommend a middle cranial fossa (MCF) approach. Several series have been published describing the advantages and disadvantages of each of these approaches . However, the strategy underlying the choice of one approach or another is often unclear, and it seems that the final choice is more related to the surgeon's habit than to a clear algorithm.…”

Spontaneous temporal cerebrospinal fluid leak

“…40 These complications are what imposes the need for surgical treatment of spontaneous CSF leaks. 2,11,14,19 However, specifically in relation to spontaneous temporal CSF leaks, no data were found on the impact of surgical approaches in reducing meningitis rates.…”

“…[5][6][7][8][9][10] Temporal CSF leaks may also be associated with the presence of herniations of the intracranial content (meningoceles and meningoencephaloceles) and with dehiscence of the superior semicircular canal. [11][12][13] The clinical presentation is usually insidious and nonspecific, which tends to delay the diagnosis. The most common signs and symptoms are effusion in the middle ear, aural fullness, dysacusis, tinnitus and clear, pulsatile and persistent otorrhea after placing a ventilation tube.…”

“…2,13 However, in some patients, the initial clinical manifestation can be meningitis, brain abscess and seizures, complications associated with spontaneous CSF leaks that impose the need for imperative surgical treatment. 2,11,13,14 The potential sites involved in temporal CSF fistulas are the tympanic tegmen, the mastoid tegmen, mastoid, petrous apex, Hyrtl's tympanomeningeal fissure, facial nerve canal and stapes platinum. Therefore, the anatomical domain of the temporal bone is essential for proper identification and management of the condition.…”