2025 Proffered Presentations
S297: TEMPORAL BONE ENCEPHALOCELES AND RELATED SIMULTANEOUS PROCEDURES
Neal Jackson; Tulane University
Introduction: Temporal bone encephaloceles are a complex problem of the skull base, often requiring surgical intervention with a multidisciplinary approach between neurosurgeons and neurotologists. While most attention is paid to the skull base repair through either middle fossa and/or transmastoid surgical approaches, often other procedures may be employed for significant patient benefit. Namely, additional procedures for care of the ear including tympanoplasty, removal of ear tube, ossicular chain reconstruction as well as use of CSF diversion instrument such as extraventricular drain or a lumbar drain.
Methods & Results: This study examines use of adjunctive procedures for patients undergoing repair of temporal bone encephaloceles. A retrospective analysis includes 55 repaired encephaloceles repaired through multidisciplinary team approach including neurosurgery and neurotology. It is worth noting that not all patients receive CSF diversion, especially if the suspected pathology is simply dural herniation without active CSF leak.
Interventions: 85% of patients underwent middle fossa encephalocele repair with at least one adjunctive procedure. 51% of patients underwent middle fossa encephalocele with at least two procedures. 98% of patients were treated with exclusively transmastoid approach to the skull base and 2% were treated with only middle fossa craniotomy. 69% of patients underwent lumbar drain; no extraventricular drains were performed. 56% of patients underwent formal tympanoplasty, and 12% underwent myringoplasty with ear tube removal. 12% also had ossicular chain reconstruction.
Discussion: For patients with encephaloceles, the use of adjunctive simultaneous procedures occurred in the vast majority of patients (85%). While lumbar drain was the most commonly employed procedure (69%), middle ear procedures such as tympanoplasty were performed 56% of the time. This study examines factors related to use of such adjunctive procedures.
Conclusion: In this study, 85% of patients underwent at least one additional procedure at the time of encephalocele repair. Though middle fossa encephaloceles may not always be managed by multidisciplinary teams at every institution, it is important for all skull base surgeons to be aware of the potential benefit of related simultaneous procedures.