title: Transmastoid extradural-intracranial approach for repair of transtemporal meningoencephalocele: a review of 31 consecutive cases.
abstract: OBJECTIVE
  To review the clinical presentation, surgical techniques, and outcomes of the transmastoid extradural-intracranial (TMEDIC) approach for the treatment of transtemporal meningoencephalocele.
  
  
  OBJECTIVE
  The TMEDIC is a safe and effective approach to repair meningoencephalocele originating from the middle or posterior cranial fossa.
  
  
  METHODS
  Retrospective chart review.
  
  
  METHODS
  Academic neurotologic tertiary referral center.
  
  
  METHODS
  Thirty-one consecutive patients diagnosed with transpetrous meningo(encephalo)cele, with or without cerebrospinal fluid leak, between January of 2003 and October of 2010.
  
  
  METHODS
  TMEDIC approach for repairing herniated neural tissue through the tegmen or posterior fossa plate using the combination of autologous cartilage, fascia, and tissue sealant.
  
  
  METHODS
  Anatomic location, size, and number of defects, presence of herniated brain tissue, pre- and postoperative hearing thresholds, and failure rate.
  
  
  RESULTS
  Mean age was 62 ± 26 years. The etiology was spontaneous in 25/31 (80%), congenital in 3/31 (10%), chronic otitis media in 2/31 (6%), and posttraumatic in 1/31 (4%). Posttympanostomy tube clear otorrhea was the presenting sign in 21/31 (68%) of patients. The mean duration of symptoms was 26 months (range: 1-240). The defect involved the middle fossa (MF) floor in 25/31 (90%). Both the tegmen tympani and mastoideum were involved in 12/31 (39%) of patients and multiple dehiscences were seen in 7/31 (22%). In 17/31 (55%) of cases the size exceeded 1 cm. No recurrences were seen.
  
  
  CONCLUSIONS
  The TMEDIC is a safe and effective method to repair transtemporal meningoencephalocele obviating the need for a middle fossa craniotomy in certain cases.
authors.affiliation: Department of Otolaryngology-Head and Neck Surgery, University Hospitals Case Medical Center, Cleveland, Ohio, USA. maroun.semaan@UHHospitals.org
authors.forename: Maroun T
authors.initials: MT
authors.lastname: Semaan
authors.forename: David A
authors.initials: DA
authors.lastname: Gilpin
authors.forename: Daniel P
authors.initials: DP
authors.lastname: Hsu
authors.forename: Jay K
authors.initials: JK
authors.lastname: Wasman
authors.forename: Cliff A
authors.initials: CA
authors.lastname: Megerian
mesh_terms: D001299:Audiometry; D004677:Encephalocele / Q000175:diagnosis / Q000000981:diagnostic imaging / Q000601:surgery*; D005260:Female; D006801:Humans; D008297:Male; D008416:Mastoid / Q000601:surgery; D008588:Meningocele / Q000175:diagnosis / Q000000981:diagnostic imaging / Q000601:surgery*; D008875:Middle Aged; D019635:Neurosurgical Procedures / Q000379:methods*; D011859:Radiography