title: Meningoencephalocele of the temporal bone: pictorial essay on transmastoid extradural-intracranial repair.
abstract: OBJECTIVE
  A spontaneous meningoencephalocele of the temporal bone may present with effusion in the middle ear, a cerebrospinal fluid leak, hearing loss, or rarely otitic meningitis. Repair of spontaneous encephaloceles in the temporal bone has been performed using transmastoid and transcranial middle fossa approaches or a combination of the two with varied results. The authors present a technical paper on the transmastoid extradural intracranial approach for the management of temporal lobe encephaloceles.
  
  
  METHODS
  Case reports and cadaver dissections are used to provide a pictorial essay on the technique. Advantages and disadvantages compared with alternative surgical approaches are discussed.
  
  
  RESULTS
  Traditional transmastoid approaches are less morbid compared with a transcranial repair as they avoid brain retraction. However, in the past, there has been a higher risk of graft failure and hearing loss due to downward graft migration and a potential need for ossicular disarticulation. For the appropriate lesion, the transmastoid extradural intracranial approach lesion offers a stable meningoencephalocele repair without the comorbidity of brain retraction.
  
  
  CONCLUSIONS
  The authors describe a transmastoid extradural intracranial technique via case reports and cadaver dissections for the repair of spontaneous meningoencephalocele defects larger than 2 cm. This approach provides more support to the graft compared to the conventional transmastoid repair.
authors.affiliation: Department of Neurosurgery, University Hospitals Case Medical Center, Cleveland, OH, USA.
authors.forename: Sunil
authors.initials: S
authors.lastname: Manjila
authors.forename: Cameron C
authors.initials: CC
authors.lastname: Wick
authors.forename: John
authors.initials: J
authors.lastname: Cramer
authors.forename: Maroun T
authors.initials: MT
authors.lastname: Semaan
authors.forename: Nicholas C
authors.initials: NC
authors.lastname: Bambakidis
authors.forename: Warren R
authors.initials: WR
authors.lastname: Selman
authors.forename: Cliff A
authors.initials: CA
authors.lastname: Megerian
mesh_terms: D000368:Aged; D004388:Dura Mater / Q000601:surgery; D004425:Ear Cartilage / Q000637:transplantation; D004677:Encephalocele / Q000209:etiology / Q000601:surgery*; D005260:Female; D006801:Humans; D008588:Meningocele / Q000209:etiology / Q000601:surgery*; D019635:Neurosurgical Procedures / Q000379:methods*; D013506:Otologic Surgical Procedures / Q000379:methods*; D013701:Temporal Bone / Q000601:surgery*