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Temporal bone meningoencephaloceles and cerebrospinal fluid leaks: experience in a tertiary care hospital

Published online by Cambridge University Press:  19 February 2019

A Gupta ,
K Sikka ,
D V K Irugu ,
H Verma ,
A S Bhalla  and
A Thakar
A Gupta
Affiliation:
Department of Otolaryngology and Head–Neck Surgery, All India Institute of Medical Sciences, New Delhi, India
K Sikka
Affiliation:
Department of Otolaryngology and Head–Neck Surgery, All India Institute of Medical Sciences, New Delhi, India
D V K Irugu
Affiliation:
Department of Otolaryngology and Head–Neck Surgery, All India Institute of Medical Sciences, New Delhi, India
H Verma
Affiliation:
Department of Otolaryngology and Head–Neck Surgery, All India Institute of Medical Sciences, New Delhi, India
A S Bhalla
Affiliation:
Department of Radiodiagnosis, All India Institute of Medical Sciences, New Delhi, India
A Thakar*
Affiliation:
Department of Otolaryngology and Head–Neck Surgery, All India Institute of Medical Sciences, New Delhi, India
*
Author for correspondence: Dr Alok Thakar, Department of Otolaryngology and Head–Neck Surgery, All India Institute of Medical Sciences, Ansari Nagar, New Delhi 110029, India E-mail: drathakar@gmail.com Fax: +91 (0)1126593492
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Abstract

Objective

To recount experience with cerebrospinal fluid otorrhoea and temporal bone meningoencephalocele repair in a tertiary care hospital.

Method

A retrospective review was conducted of 16 cerebrospinal fluid otorrhoea and meningoencephalic herniation patients managed surgically from 1991 to 2016.

Results

Aetiology was: congenital (n = 3), post-traumatic (n = 2), spontaneous (n = 1) or post-mastoidectomy (n = 10). Surgical repair was undertaken by combined middle cranial fossa and transmastoid approach in 3 patients, transmastoid approach in 2, oval window plugging in 1, and subtotal petrosectomy with middle-ear obliteration in 10. All patients had successful long-term outcomes, except one, who experienced recurrence after primary stage oval window plugging, but has been recurrence-free after second-stage subtotal petrosectomy with middle-ear obliteration.

Conclusion

Dural injury or exposure in mastoidectomy may lead to cerebrospinal fluid otorrhoea or meningoencephalic herniation years later. Congenital, spontaneous and traumatic temporal bone defects may present similarly. Middle cranial fossa dural repair, transmastoid multilayer closure and subtotal petrosectomy with middle-ear obliteration were successful procedures. Subtotal petrosectomy with middle-ear obliteration offers advantages over middle cranial fossa dural repair alone; soft tissue closure is more robust and is preferred in situations where hearing preservation is not a priority.

Keywords

Temporal BoneEncephaloceleCerebrospinal Fluid OtorrheaCerebrospinal Fluid RhinorrheaMeningitisCranial Fossa, MiddleOtitis MediaCholesteatoma, Middle EarMastoidEar, Middle
Type
Main Articles
Information
The Journal of Laryngology & Otology , Volume 133 , Issue 3 , March 2019 , pp. 192 - 200
Copyright
Copyright © JLO (1984) Limited, 2019 

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Footnotes

Dr A Thakar takes responsibility for the integrity of the content of the paper

Presented as a paper at the Indian Society of Otology conference, 20 November 2017, Raipur, India.

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