OBJECTIVE: To review the clinical presentation, surgical techniques, and outcomes of the transmastoid extradural-intracranial (TMEDIC) approach for the treatment of transtemporal meningoencephalocele. HYPOTHESIS: The TMEDIC is a safe and effective approach to repair meningoencephalocele originating from the middle or posterior cranial fossa. STUDY DESIGN: Retrospective chart review. SETTING: Academic neurotologic tertiary referral center. PATIENTS: Thirty-one consecutive patients diagnosed with transpetrous meningo(encephalo)cele, with or without cerebrospinal fluid leak, between January of 2003 and October of 2010. INTERVENTION: TMEDIC approach for repairing herniated neural tissue through the tegmen or posterior fossa plate using the combination of autologous cartilage, fascia, and tissue sealant. MAIN OUTCOME MEASURES: Anatomic location, size, and number of defects, presence of herniated brain tissue, pre- and postoperative hearing thresholds, and failure rate. RESULTS: Mean age was 62 ± 26 years. The etiology was spontaneous in 25/31 (80%), congenital in 3/31 (10%), chronic otitis media in 2/31 (6%), and posttraumatic in 1/31 (4%). Posttympanostomy tube clear otorrhea was the presenting sign in 21/31 (68%) of patients. The mean duration of symptoms was 26 months (range: 1-240). The defect involved the middle fossa (MF) floor in 25/31 (90%). Both the tegmen tympani and mastoideum were involved in 12/31 (39%) of patients and multiple dehiscences were seen in 7/31 (22%). In 17/31 (55%) of cases the size exceeded 1 cm. No recurrences were seen. CONCLUSION: The TMEDIC is a safe and effective method to repair transtemporal meningoencephalocele obviating the need for a middle fossa craniotomy in certain cases.
OBJECTIVE: To review the clinical presentation, surgical techniques, and outcomes of the transmastoid extradural-intracranial (TMEDIC) approach for the treatment of transtemporal meningoencephalocele. HYPOTHESIS: The TMEDIC is a safe and effective approach to repair meningoencephalocele originating from the middle or posterior cranial fossa. STUDY DESIGN: Retrospective chart review. SETTING: Academic neurotologic tertiary referral center. PATIENTS: Thirty-one consecutive patients diagnosed with transpetrous meningo(encephalo)cele, with or without cerebrospinal fluid leak, between January of 2003 and October of 2010. INTERVENTION: TMEDIC approach for repairing herniated neural tissue through the tegmen or posterior fossa plate using the combination of autologous cartilage, fascia, and tissue sealant. MAIN OUTCOME MEASURES: Anatomic location, size, and number of defects, presence of herniated brain tissue, pre- and postoperative hearing thresholds, and failure rate. RESULTS: Mean age was 62 ± 26 years. The etiology was spontaneous in 25/31 (80%), congenital in 3/31 (10%), chronic otitis media in 2/31 (6%), and posttraumatic in 1/31 (4%). Posttympanostomy tube clear otorrhea was the presenting sign in 21/31 (68%) of patients. The mean duration of symptoms was 26 months (range: 1-240). The defect involved the middle fossa (MF) floor in 25/31 (90%). Both the tegmen tympani and mastoideum were involved in 12/31 (39%) of patients and multiple dehiscences were seen in 7/31 (22%). In 17/31 (55%) of cases the size exceeded 1 cm. No recurrences were seen. CONCLUSION: The TMEDIC is a safe and effective method to repair transtemporal meningoencephalocele obviating the need for a middle fossa craniotomy in certain cases.
Authors: Amit Walia; Daniel Lander; Nedim Durakovic; Matthew Shew; Cameron C Wick; Jacques Herzog Journal: Am J Otolaryngol Date: 2020-10-24 Impact factor: 1.808