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Posttraumatic Temporal Bone Meningocele Presenting as a Cystic Mass in the External Auditory Canal
Babak Alijani1, Hamid Reza Bagheri, Shahrokh Yousefzadeh Chabok
1*Departments of Neurosurgery †Otorhinolaryngology, Guilan University of Medical Sciences, Rasht, Iran.
Insights
Temporal bone meningoencephaloceles, a rare complication of head trauma, present subtly. Early diagnosis via imaging and surgical repair are crucial for managing this condition.
Area of Science:
- Neurosurgery
- Otolaryngology
- Radiology
Background:
- Temporal bone meningoencephalic herniation is a rare but serious consequence of head trauma.
- Understanding the anatomical routes of herniation is critical for diagnosis and treatment.
- Potential complications include neurological deficits and cerebrospinal fluid leaks.
Observation:
- An 11-year-old boy presented with progressive hearing loss, facial weakness, and an external auditory canal mass after head trauma.
- Symptoms developed over 9 months, indicating a slow progression of the meningoencephalocele.
- A cystic mass in the external auditory canal was a key presenting sign.
Findings:
- Surgical intervention involved a mini middle cranial fossa craniotomy combined with a transmastoid approach.
- Multilayer closure of the bony defect is essential to prevent cerebrospinal fluid leakage.
- Combined CT and MRI are vital for accurate preoperative diagnosis.
Implications:
- Early clinical suspicion and advanced imaging are key to diagnosing subtle cases of temporal bone meningoencephaloceles.
- Surgical approaches, including transmastoid and middle cranial fossa repairs, can effectively manage these defects.
- Prompt diagnosis and surgical management can prevent severe complications and improve patient outcomes.
Introduction:
Temporal bone meningoencephalic herniation may occur in head trauma. It is a rare condition with potentially dangerous complications. Several different routes for temporal bone meningoencephalocele have been proposed.
Clinical Report:
An11-year-old boy with history of head trauma initially presented with a 9-months history of progressive right-sided hearing loss and facial weakness. The other complaint was formation of a cystic mass in the right external auditory canal. The patient underwent surgery via a mini middle cranial fossa craniotomy associated with a transmastoid approach.
Conclusion:
Although presenting symptoms can be subtle, early suspicion and confirmatory imaging aid in establishing the diagnosis. The combination of computed tomography and magnetic resonance imaging will help in proper preoperative diagnosis. The operation includes transmastoid, middle cranial fossa repair, or combination of both. The multilayer closure of bony defect is very important to avoid cerebrospinal fluid leak. Clinical manifestations, diagnosis, and surgical approaches for posttraumatic meningoencephaloceles arising in the head and neck region are briefly discussed.
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