Combined Mastoidectomy and Middle Fossa Craniotomy for Tegmen Defect Repair: Long-Term Outcomes Using a Multidisciplinary Approach.

BACKGROUND AND

OBJECTIVES

Tegmen tympani and tegmen mastoideum defects can be accompanied either with or without encephaloceles and can result in cerebrospinal fluid (CSF) leaks. The tegmen region is a very thin segment of a dependent area of the temporal bone, making it susceptible to dehiscence with CSF pulsations over time. Approaches for repair generally consist of middle fossa (MF), transmastoid (TM), or a combination of the two (MF + TM). Surgical repair of tegmen defects commonly consists of meningocele removal when present, followed by dural repair. This is often followed by reconstruction of the bony defect. There are a number of repair methods that have been described in series of smaller size without long-term follow-up. Our series includes the current largest number of patients undergoing a combined approach (MF + TM), with up to 16-year follow-up. We provide clinical and illustrative demonstration of our repair technique.

METHODS

A retrospective review was performed of patients with tegmen defects who underwent a combined mastoidectomy with MF craniotomy for surgical repair by a multidisciplinary team between September 2006 and December 2023.

RESULTS

A total of 103 tegmen repair operations were performed in 97 patients with tegmen defects, with 6 (6.2%) of these patients having bilateral defects requiring staged bilateral operations. Sixty-seven (65.0%) were spontaneous etiology. The second most common etiology was history of infection (19.4%). No patients required return to operating room for CSF leak at the site of repair. Average length of stay was 2.5 days. Follow-up for this series was as long as 16 years.

CONCLUSION

A multidisciplinary combined mastoidectomy and MF craniotomy with dural onlay and titanium mesh repair, with or without lumbar drain, can serve as an effective long-term method for surgical repair of tegmen defects.