Multilayer reconstruction technique for temporal bone dehiscence: a single-center experience with cadaveric...

Area of Science:

• Neurosurgery
• Otolaryngology
• Skull Base Surgery

Background:

• Temporal bone dehiscence (TBD) presents varied symptoms and requires surgical repair to address intracranial-middle ear communication.
• Common TBD variations include tegmen and superior semicircular canal dehiscence.
• Surgical goals involve repairing defects and preventing cerebrospinal fluid (CSF) leakage.

Purpose of the Study:

• To describe a novel multilayer reconstruction technique for TBD.
• To detail the relevant surgical anatomy through cadaveric dissection.
• To evaluate the outcomes of TBD repair using the middle cranial fossa (MCF) approach.

Main Methods:

• Retrospective analysis of 29 patients undergoing 33 TBD repairs via MCF approach (January 2016 - December 2023).
• Utilized a multilayer reconstruction technique tailored to individual defect needs.
• Encephalocele removal and dural defect repair were performed in 24 procedures.

Main Results:

• Significant symptom improvement (96.6%) including hearing loss, CSF otorrhea, and vertigo.
• Nine additional patients diagnosed with idiopathic intracranial hypertension (IIH) post-surgery, enabling timely treatment.
• Multilayer reconstruction proved effective in addressing TBD and associated complications.

Conclusions:

• The MCF approach with multilayer reconstruction offers favorable outcomes for TBD repair.
• Early identification and management of IIH are critical in TBD patients.
• This technique effectively resolves symptoms and reduces recurrence risk.