Author(s)
Pamela C. Roehm, MD, PhD
Derrick Tint, MD
Norman Chan, MD
Vishad Sukul, MD
Kadir Erkmen, MD
Affiliation(s)
Abstract:
Objective: Temporal lobe encephaloceles and cerebrospinal fluid otorrhea from temporal bone defects that involve the tegmen tympani and mastoideum are general repaired using middle fossa, mastoidectomy, or combined approaches. Standard middle fossa craniotomy exposes patients to dural retraction which may lead to postoperative neurologic complications. Here we describe novel approach using endoscope visualization through a keyhole middle fossa craniotomy to repair tegmen defects. Study design: Retrospective case review of a series of patients treated for temporal encephaloceles or cerebrospinal fluid originating from defects in the tegmen utilizing an endoscopic-assisted middle fossa keyhole craniotomy approach. Setting: Tertiary referral center. Patients: Patients included in the study underwent endoscopic-assisted or fully endoscopic repairs of temporal encephalocele and/ or cerebrospinal fluid otorrhea originating from a defect in the tegmen. Only adult patients were included. Patients of multiple ethnicities and body mass indices were included. Intervention: Endoscopic-assisted or fully endoscopic middle fossa repair of tegmen dehiscence through a keyhole craniotomy approach. Main outcome measure: Recurrence of cerebrospinal fluid otorrhea or temporal encephalocele. Results: All cases were performed successfully using a keyhole craniotomy with endoscopic visualization and minimal retraction. There were no recurrences of encephaloceles or cerebrospinal fluid otorrhea in these patients. Additionally, surgical times did not increase. There were no major postoperative complications within this series. Conclusions: Endoscopic visualization allows for smaller incisions and craniotomies and less risk of brain retraction injury without compromising repair integrity during temporal lobe encephalocele and tegmen repairs. Define Professional Practice Gap & Educational Need: lack of knowledge of added advantage of use of endoscopy for visualization for care of temporal encephaloceles and cerebrospinal otorrhea Learning Objective: Introduction of the technique of endoscopic visualization of the tegmen via a middle fossa keyhole craniotomy approach in the surgical treatment of temporal lobe encephaloceles and cerebrospinal fluid otorrhea Desired Result: Attendees will understand the technique and advantages of the use of endoscopic visualization of the tegmen in the surgical treatment of temporal lobe encephaloceles and cerebrospinal fluid otorrhea Indicate IRB or IACUC Approval: Approved