Combined Approach for Tegmen Defects Repair in Patients with Cerebrospinal Fluid Otorrhea or Herniations: Our Experience

Abstract

Objectives?To describe our departmental experience in the surgical repair of tegmen tympani defects using a combined transmastoid/minicraniotomic approach. Design?Retrospective review of videos from surgery and patients' charts. Setting?Tertiary university referral center. Participants?Twenty-two patients who underwent surgical repair of tegmen defects associated with cerebrospinal fluid (CSF) leakage and/or meningocele/meningoencephalocele by a combined transmastoid/minicraniotomic approach. Main Outcome Measures?A retrospective review of videos of surgery and charts of patients with tegmen tympani or tegmen antri defects and CSF leakage, temporal lobe encephalocele, and/or meningoencephalocele. Results?All patients underwent the combined approach and had their defects closed, without significant intraoperative or postoperative complications. Conclusions?Mastoidectomy with temporal minicraniotomy represents an effective approach in patients with tegmen tympani dehiscence; the advantages of this technique are the control of the floor of the middle cranial fossa and the possibility to reach bony defects located anteriorly without manipulation of the ossicular chain and temporal lobe.

Our experience in the management of csf otorrhea: a transmastoid approach with middle ear cavity obliteration and a middle cranial fossa approach

“…In anterior, multiple, or large defects, the transmastoid approach does not guarantee permanent cessation of the leakage (9). Middle ear obliteration may also supplement this technique to provide an additional safety measure (2) to patients with a nonserviceable hearing level or a large encephalocele (9), which was seen in our first case.…”

“…The transmastoid approach has been reported as the most familiar and comfortable route for otolaryngologists (5,11,13), and is accepted to be sufficient by itself for most cases (8,11). It allows sufficient access to the posterior fossa or lateral tegmen tympani fistulas; however, the medial tegmen tympani can be underexposed necessitating the removal of parts of the ossicular chain (9). In anterior, multiple, or large defects, the transmastoid approach does not guarantee permanent cessation of the leakage (9).…”

“…It allows sufficient access to the posterior fossa or lateral tegmen tympani fistulas; however, the medial tegmen tympani can be underexposed necessitating the removal of parts of the ossicular chain (9). In anterior, multiple, or large defects, the transmastoid approach does not guarantee permanent cessation of the leakage (9). Middle ear obliteration may also supplement this technique to provide an additional safety measure (2) to patients with a nonserviceable hearing level or a large encephalocele (9), which was seen in our first case.…”

Management of Spontaneous Cerebrospinal Fluid Leaks in the Middle Cranial Fossa and Bone Tegmen Tympani Defect in Patients with Meningitis and Rhinorrhea

“…Usually, this approach is used when patients present with otorrhea and hearing loss. Alternatively, it is used to treat small defects of posterior cranial fossa [23].…”

Management of tegmen defects with mastoid and epitympanic obliteration using S53P4 bioactive glass

“…The transmastoid approach is generally proposed only for small bony defects . In the literature, the MCFA is preferred when there is a large defect since, for large defects, the MCFA is supposed to provide better control of the edges of the defect and ensure a safer repair . An interesting technique was proposed by Marchioni et al who combined the transmastoid approach with a minicraniotomy for the repair of the tegmen bony defect; this technique could be particularly interesting in the repair of a tegmen tympani bony defect with intact ossicular chain since it limits the extent of the craniotomy.…”