Meningoencephalocele of the middle ear cleft: Three tier management.

Meningoencephalic herniation into the middle ear is a rare condition that can be life threatening for the patient due to eventual infective intracrunial complications. It is characterized by a bony and dural defect localized in the tegmen through which meninges and encephalic tissue can herniate. Meningoencephalic hernia of the middle ear can appear as an insidious complication of Chronic mastoiditis (infective) and its surgery, trauma or spontaneous. High resolution computed tomography (CT scan) and Magnetic resonance imaging (MRI) must be done to evaluate the extent and the contents of the disease. Early and effective surgical repair, the only appropriate treatment, is necessary to avoid complication and recurrence. Middle cranial fossa, mastoid, combined approaches and obliteration of mastoid; external auditory canal and middle ear are the surgical procedures for the repair of hernias. Various materials viz. fascia/ muscle/fat / cartilage/ bones/ synthetic materials are used. Recurrence of the repaired herniation has been reported. To overcome the problem of recurrence and have a foolproof method, a three tier management is described and suggested. ABSTRACT: Meningoencephalocele, brain hemiation.