Pediatric meningocele with cerebrospinal fluid drainage into the subcutaneous tissue of the external auditory canal.

Otogenic cerebrospinal fluid (CSF) leakage, particularly idiopathic meningocele, is rare in children. Here, we report a pediatric case characterized by preserved middle ear aeration and an unusual presentation of CSF leakage into the subcutaneous tissue of the external auditory canal. A 2-year-old girl who initially presented with refractory otitis media showed ossicular demineralization and internal auditory canal expansion on CT. At the age of 10 years, the patient exhibited improved middle ear aeration on imaging but had persistent symptoms; therefore, exploratory tympanotomy was performed. Intraoperative findings revealed a CSF leakage that originated from the anterior epitympanum and extended laterally into the subcutaneous tissue of the external auditory canal. This caused canal swelling and a pulsatile tympanic membrane, notably in the absence of middle ear effusion. Surgical repair using fascia, multilayered DuraGenⓇ, and lumbar drainage successfully controlled the leakage. Postoperative imaging confirmed resolution of the subcutaneous CSF leakage and identified meningoceles in the anterior tympanic cavity and internal auditory canal. Unlike typical temporal bone meningoceles, which typically present with tegmen defects and middle ear effusion, this case demonstrates that the CSF may bypass the middle ear and track directly into the subcutaneous tissue. Recognition of this rare pattern is essential for accurate diagnosis and safe surgical planning.