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Middle cranial fossa approach to repair of temporal bone encephaloceles and CSF leaks with over 18 years experience with future implications on driving regulations in the UK

Presenting Author: Jeyanthi Kulasegarah

Published online by Cambridge University Press:  03 June 2016

Jeyanthi Kulasegarah ,
Emma Hoskison ,
Karam Narang ,
Scott Mitchell  and
Richard Irving
Jeyanthi Kulasegarah
Affiliation:
Queen Elizabeth Hospital Birmingham
Emma Hoskison
Affiliation:
Queen Elizabeth Hospital Birmingham
Karam Narang
Affiliation:
Queen Elizabeth Hospital Birmingham
Scott Mitchell
Affiliation:
Queen Elizabeth Hospital Birmingham
Richard Irving
Affiliation:
Queen Elizabeth Hospital Birmingham
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Abstract

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Learning Objectives: Good hearing outcomes. Minimal risk of epilepsy. DVLA should reconsider band on driving for these patients.

Introduction: This paper details our experience in the management of 40 patients with temporal bone encephaloceles and cerebrospinal fluid (CSF) leaks, with the majority of patients managed via a middle cranial fossa approach (MCF) with bone graft, temporalis fascia and tissel. DVLA imposes a driving band for 6 months for cars and 2 years for HGV on all patients undergoing craniotomy regardless of indication.

Objective: To investigate the long-term follow-up of patients who had CSF leak repair: looking at effectiveness of repair, intracranial complications specifically seizures and hearing outcomes.

Method: A retrospective chart review of 40 patients undergone middle cranial fossa craniotomy for the treatment tegmen defect in a tertiary referral center from 1997 to 2015 was performed.

Results: Forty patients were identified who had undergone surgical repair of the dural defects through a middle cranial fossa approach. The mean age was 52 years (range 16 to 74) with male to female ratio of 2:3. Defects were almost equally right and left sided with over 80% were spontaneous leaks. Nearly 90% of patients were treated with MCF approach and 10% with a combination of MCF and transmastoid as the defect also involved the posterior fossa. Majority of patients exhibited an improvement in hearing. A patient developed epilepsy post-operatively with MRI confirmation of temporal lobe inflammation. One other patient with pre-operative epilepsy continued to have seizures.

Conclusion: The MCF approach is an excellent route to effectively repair CSF leaks and encephaloceles due to tegmen tympani and dural defect. It carries an extremely small risk of epilepsy. Therefore, the band on driving enforced by DVLA for patients with no preoperative epilepsy undergoing craniotomy for CSF leak repair should be reconsidered.