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Combined Mastoidectomy and Middle Fossa Craniotomy for Tegmen Defect Repair: Long-Term Outcomes Using a

Kara A Parikh1, Emal Lesha1, Mustafa Motiwala1

  • 1Department of Neurosurgery, The University of Tennessee Health Sciences Center, Memphis , Tennessee , USA.

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PubMed
Summary
This summary is machine-generated.

This study shows that a combined middle fossa and transmastoid approach effectively repairs tegmen defects, preventing cerebrospinal fluid leaks long-term. This surgical technique offers a durable solution for complex temporal bone issues.

Keywords:
CSF leakEncephaloceleMiddle fossaSkull baseTegmenTransmastoid

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Area of Science:

  • Neurosurgery
  • Otolaryngology
  • Skull Base Surgery

Background:

  • Tegmen tympani and mastoideum defects can lead to cerebrospinal fluid (CSF) leaks.
  • The temporal bone's tegmen is thin and prone to defects.
  • Previous repair methods lack extensive long-term follow-up.

Purpose of the Study:

  • To evaluate the long-term efficacy of a combined middle fossa (MF) and transmastoid (TM) approach for tegmen defect repair.
  • To present the largest series to date of patients undergoing this combined surgical technique.
  • To demonstrate the clinical and illustrative aspects of the repair method.

Main Methods:

  • Retrospective review of patients undergoing combined mastoidectomy and MF craniotomy.
  • Surgical repair performed by a multidisciplinary team between September 2006 and December 2023.
  • Inclusion of patients with various tegmen defect etiologies.

Main Results:

  • 103 repairs in 97 patients with tegmen defects.
  • No patients required reoperation for CSF leak at the repair site.
  • Long-term follow-up up to 16 years demonstrated sustained effectiveness.

Conclusions:

  • A combined multidisciplinary approach using MF craniotomy and TM mastoidectomy is effective for long-term tegmen defect repair.
  • Dural onlay and titanium mesh reconstruction provide a robust repair.
  • This method, with or without lumbar drain, offers a reliable surgical solution.