Search tips
Search criteria 


Logo of skullbasesurgInstructions for AuthorsSubscribe to Skull BaseAbout Skull BaseEditorial BoardThieme Medical PublishingSkull Base An Interdisciplinary Approach ...
Skull base surgery. 1998; 8(4): 185–189.
PMCID: PMC1656713

Combined Mastoid/Middle Cranial Fossa Repair of Temporal Bone Encephalocele


Temporal bone encephalocele (TBE) has become less common as the incidence of chronic mastoid infection and surgery for this condition has decreased. Due to its declining incidence, the diagnosis of TBE may be delayed and result in the development of serious complications such as cerebrospinal fluid leak, meningitis, epidural or subdural abscess. Six cases of large (>1 cm) TBE of diverse etiology are described. Two patients had suffered previous temporal bone fractures, two had had prior mastoidectomy, and two patients had long-standing chronic mastoiditis. Two patients had undergone prior unsuccessful transmastoid repair. All patients underwent successful tegmen-dural repair with autogenous fascia, bone, and/or cartilage, primarily via a combined mastoid-middle fossa approach. Accurate dural closure and support of intacranial contents are imperative to prevent recurrence. We find that permanent repair can best be performed with a combined mastoid middle cranial fassa approach.

Full text

Full text is available as a scanned copy of the original print version. Get a printable copy (PDF file) of the complete article (1.7M), or click on a page image below to browse page by page. Links to PubMed are also available for Selected References.

Images in this article

Click on the image to see a larger version.

Selected References

These references are in PubMed. This may not be the complete list of references from this article.
  • Arìstegui M, Falcioni M, Saleh E, Taibah A, Russo A, Landolfi M, Sanna M. Meningoencephalic herniation into the middle ear: a report of 27 cases. Laryngoscope. 1995 May;105(5 Pt 1):512–518. [PubMed]
  • Iurato S, Ettorre GC, Selvini C. Brain herniation into the middle ear: two idiopathic cases treated by a combined intracranial-mastoid approach. Laryngoscope. 1989 Sep;99(9):950–954. [PubMed]
  • Ferguson BJ, Wilkins RH, Hudson W, Farmer J., Jr Spontaneous CSF otorrhea from tegmen and posterior fossa defects. Laryngoscope. 1986 Jun;96(6):635–644. [PubMed]
  • Langman AW, Chu FW, Lindeman RC. Spontaneous posterior fossa cerebrospinal fluid leak. Otolaryngol Head Neck Surg. 1993 Feb;108(2):192–195. [PubMed]
  • Hyson M, Andermann F, Olivier A, Melanson D. Occult encephaloceles and temporal lobe epilepsy: developmental and acquired lesions in the middle fossa. Neurology. 1984 Mar;34(3):363–366. [PubMed]
  • Lalwani AK, Jackler RK, Harsh GR, 4th, Butt FY. Bilateral temporal bone encephaloceles after cranial irradiation. Case report. J Neurosurg. 1993 Oct;79(4):596–599. [PubMed]
  • Neely JG, Kuhn JR. Diagnosis and treatment of iatrogenic cerebrospinal fluid leak and brain herniation during or following mastoidectomy. Laryngoscope. 1985 Nov;95(11):1299–1300. [PubMed]
  • Glasscock ME, 3rd, Dickins JR, Jackson CG, Wiet RJ, Feenstra L. Surgical management of brain tissue herniation into the middle ear and mastoid. Laryngoscope. 1979 Nov;89(11):1743–1754. [PubMed]
  • Graham MD. Surgical management of dural and temporal lobe herniation into the radical mastoid cavity. Laryngoscope. 1982 Mar;92(3):329–331. [PubMed]
  • Montgomery WW. Dural defects of the temporal bone. Am J Otol. 1993 Nov;14(6):548–551. [PubMed]
  • Dedo HH, Sooy FA. Endaural brain hernia (encephalocele). Diagnosis and treatment. Laryngoscope. 1970 Jul;80(7):1090–1099. [PubMed]
  • Golding-Wood DG, Williams HO, Brookes GB. Tegmental dehiscence and brain herniation into the middle ear cleft. J Laryngol Otol. 1991 Jun;105(6):477–480. [PubMed]

Articles from Skull Base Surgery are provided here courtesy of Thieme Medical Publishers