Temporal bone encephalocele and cerebrospinal fluid leaks.

Nineteen cases of temporal bone brain herniation and cerebrospinal fluid (CSF) leaks in 17 adult patients since 1987 are reviewed. Of these 19 cases, 11 were spontaneous CSF leaks, 6 were related to chronic otitis media, and 2 were posttraumatic. Among the 10 women and 7 men, the average age was 51.2 years, with average follow-up time of 2 years, 7 months. Two cases were repaired by a middle fossa craniotomy approach, 1 case by a transmastoid approach, and 16 by a combined transmastoid and middle fossa approach. Ten cases utilized the preferred technique of fascia-bone-fascia to repair the defects. The diagnosis was made on clinical grounds in 18 of the 19 cases, with ancillary diagnostic test providing little useful information. There were no postoperative surgery-related complications, and definitive repair was accomplished in one stage in all cases.