Temporal Bone Meningo-Encephalic-Herniation: Etiological Categorization and Surgical Strategy

Area of Science:

• Neurosurgery
• Otolaryngology
• Skull Base Surgery

Background:

• Meningo-encephalic-herniation (MEH) presents diverse clinical scenarios.
• Understanding MEH etiology is crucial for effective management.
• Previous reports on MEH have been published, necessitating updated findings.

Purpose of the Study:

• To investigate the clinical presentation, intraoperative findings, and surgical management of MEH.
• To correlate MEH etiology with specific clinical and surgical characteristics.
• To provide guidance for surgical approach selection based on MEH cause.

Main Methods:

• Retrospective clinical study of 262 operated ears with intraoperatively verified MEH.
• Inclusion criteria: minimum 12-month follow-up.
• Data collection included demographics, etiology, clinical presentation, surgical approach, and outcomes.

Main Results:

• MEH etiologies included chronic otitis media (COM/CHOL-MEH, 47.7%), iatrogenic (20.9%), spontaneous (23.3%), and traumatic (8%).
• Clinical presentations varied by etiology: hearing loss and otorrhea common in COM/CHOL-MEH and iatrogenic MEH; meningitis and CSF leak more pronounced in spontaneous and traumatic MEH.
• Surgical approaches varied, with middle-ear-obliteration (MEO) used in COM/CHOL-MEH and iatrogenic MEH, and middle-cranial-fossa approach for spontaneous and traumatic MEH.

Conclusions:

• Etiology-based classification of MEH is essential for guiding surgical decisions.
• Middle-ear-obliteration (MEO) is a valuable technique for definitive MEH management when indicated.
• Tailoring surgical strategies to the underlying cause of MEH improves outcomes.