Combined Approach for Giant Temporal Meningoencephalocele

Document Type : Case Report

Authors

1 Department of ENT and Head and Neck, Hospital University Son Espases, Palma de Mallorca, Spain and Department of ENT and Head and Neck, Rotger Clinic, Palma de Mallorca, Spain.

2 Department of ENT and Head and Neck, Hospital University Son Espases, Palma de Mallorca, Spain.

Abstract

Introduction:
To present a complex case of giant meningoencephalocele after a canal wall down mastoidectomy and describe our preferred approach to repair meningoencephalic herniation of the temporal bone.
Case Report:
A 20-year-old patient, who had previously undergone type III tympanoplasty with total ossicular reconstruction prosthesis for an attic cholesteatoma, presents with clinical and imaging features compatible with the diagnosis of a giant temporal meningoencephalocele. We performed a combined approach –transmastoid plus minicraniotomy- to repair the skull base defect. A multilayer reconstruction of the defect with septal cartilage and temporal fascia was performed. After a 48 months follow-up, the patient remains symptom free without signs of tissue herniation.
Conclusions:
Transmastoid plus minicraniotomy combined approach is a safe and feasible technique in case of large and anterior skull base defects with low surgical morbidity, allowing a safe and multilayered reconstruction, even in the context of a simultaneous active chronic otitis media.

Keywords