Mini-craniotomy for management of CSF otorrhea from tegmen defects

CSF otorrhea arising from defects in the tegmen and middle fossa dura may be congenital or acquired. It may be spontaneous or secondary to trauma, chronic ear disease, tumor or surgical treatment. In the six cases presented, the tegmen defect and associated CSF leak were secondary to chronic ear disease in two cases, to mastoid surgery in two cases, to temporal bone fracture and congenital origin in one case each. The successful management of these patients utilizing a mini-craniotomy in conjunction with mastoid surgery is described. Mini-craniotomy facilitates precise extradural, intracranial placement of an autogenous graft over the tegmen defect which can be technically difficult in the transmastoid approaches, yet avoids the morbidity and potential complications of a full middle fossa craniotomy. It does not significantly add to the length of the mastoid procedure or its complications.