title: Dilemmas in the treatment of concurrent bilateral meningoencephalocele and superior semicircular canal dehiscence.
abstract: OBJECTIVE
  To report on a patient with bilateral meningoencephalocele complicated by bilateral asymptomatic superior semicircular canal dehiscence and discuss dilemmas associated with his successful surgical treatment.
  
  
  METHODS
  Case capsule report.
  
  
  METHODS
  Tertiary academic medical center.
  
  
  METHODS
  A 56-year-old man with 6 years of progressive conductive hearing loss and recent spontaneous cerebrospinal fluid leak from the right ear diagnosed as having bilateral large temporal bone meningoencephalocele (ME) and concomitant bilateral asymptomatic superior semicircular canal dehiscence (SSCD).
  
  
  RESULTS
  The right ME was repaired through the middle fossa approach, and the right SSCD was plugged. To avoid the risk associated with bilaterally plugging the SSCDs, the left ME was sealed by subtotal petrosectomy, blind sac closure of the external auditory canal, plugging of the eustachian tube orifice, and obliteration of the residual space with an abdominal fat graft. The herniated brain and meninges were amputated, and the tissue present in the attic was not disrupted. Hearing was reconstructed with a two-staged Bone-anchored Hearing Aid procedure to avoid the risk of cerebrospinal fluid leaking through the skin defect of the Bone-anchored Hearing Aid abutment.
  
  
  CONCLUSIONS
  Temporal bone ME can be associated with asymptomatic SSCD. We illustrate an example of how patients with bilateral pathologies can be managed effectively with good vestibular, auditory, and cosmetic results.
authors.affiliation: *Sackler School of Medicine, Tel Aviv University; †Departments of Neurosurgery, and ‡Otolaryngology, Head, Neck and Maxillofacial Surgery, Tel Aviv Sourasky Medical Center, Tel Aviv, Israel.
authors.forename: Garrett
authors.initials: G
authors.lastname: Locketz
authors.forename: Nevo
authors.initials: N
authors.lastname: Margalit
authors.forename: Lior
authors.initials: L
authors.lastname: Gonen
authors.forename: Dan M
authors.initials: DM
authors.lastname: Fliss
authors.forename: Ophir
authors.initials: O
authors.lastname: Handzel
mesh_terms: D004677:Encephalocele / Q000150:complications* / Q000473:pathology / Q000601:surgery*; D006801:Humans; D007759:Labyrinth Diseases / Q000150:complications* / Q000601:surgery*; D008297:Male; D008588:Meningocele / Q000150:complications* / Q000473:pathology / Q000601:surgery*; D008875:Middle Aged; D012665:Semicircular Canals / Q000473:pathology