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Skull Base 2007; 17(5): 311-316
DOI: 10.1055/s-2007-986429
CASE REPORT

© Thieme Medical Publishers

Idiopathic Temporal Bone Encephalocele

V. Papanikolaou1 , A. Bibas1 , E. Ferekidis1 , S. Anagnostopoulou3 , J. Xenellis2
  • 11st Department of Otolaryngology, Hippokration Hospital, University of Athens Medical School, Athens, Greece
  • 22nd Department of Otolaryngology, Attikon Hospital, University of Athens Medical School, Athens, Greece
  • 3Department of Anatomy, University of Athens Medical School, Athens, Greece
Further Information

Publication History

Publication Date:
07 September 2007 (online)

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ABSTRACT

Meningoencephaloceles are herniations of brain tissue through dehiscences of the skull base. These skull defects are either acquired (otologic infection, trauma, surgery, neoplasia) or spontaneous. Spontaneous temporal bone meningoencephaloceles are quite rare conditions, usually congenital in origin presenting during childhood, and only occasionally idiopathic presenting during adulthood. We present a case of temporal bone meningoencephalocele of adult onset. The patient was treated with exploratory mastoidectomy, amputation of the herniated cele and closure of the defect with temporalis fascia and an inferiorly based pedicled muscular flap. No reconstruction of the bony defect was performed, as the layered closure was considered adequate. Twelve months' follow-up revealed no relapse of the condition or postoperative complications.

KEYWORDS

Temporal bone - meningoencephalocele - brain herniation

REFERENCES

  • 1 Jackson C G, Pappas Jr D G, Manolidis S et al.. Brain herniation into the middle ear and mastoid: concepts in diagnosis and surgical management.  Am J Otol. 1997;  18 198-205 discussion 205-206
    PubMedGoogle Scholar
  • 2 MacRae D L, Ruby R F. Recurrent meningitis secondary to perilymph fistula in young children.  J Otolaryngol. 1990;  19 222-225
    PubMedGoogle Scholar
  • 3 Phillipps J J. Bilateral oval window fistulae with recurrent meningitis.  J Laryngol Otol. 1986;  100 329-331
    PubMedGoogle Scholar
  • 4 Quiney R E, Mitchell D B, Djazeri B, Evans J G. Recurrent meningitis in children due to inner ear abnormalities.  J Laryngol Otol. 1989;  103 473-480
    PubMedGoogle Scholar
  • 5 Barr B, Wersall J. Cerebrospinal otorrhea with meningitis in congenital deafness.  Arch Otolaryngol. 1965;  81 26-28
    PubMedGoogle Scholar
  • 6 Bennett R J. On subarachnoid-tympanic fistulae: a report of two cases of the rare indirect type.  J Laryngol Otol. 1966;  80 1242-1252
    PubMedGoogle Scholar
  • 7 Biggers W P, Howell N N, Fisher N D, Himadi G M. Congenital ear anomalies associated with otic meningitis.  Arch Otolaryngol. 1973;  97 399-401
    PubMedGoogle Scholar
  • 8 Tschiang H H, Harrison M S, Ozsahinaglu C A. Cerebro-spinal otorrhoea.  J Laryngol Otol. 1973;  87 475-483
    PubMedGoogle Scholar
  • 9 Weider D J, Geurkink N A, Saunders R L. Spontaneous cerebrospinal fluid otorhinorrhea.  Am J Otol. 1985;  6 416-422
    PubMedGoogle Scholar
  • 10 Schick B, Draf W, Kahle G, Weber R, Wallenfang T. Occult malformations of the skull base.  Arch Otolaryngol Head Neck Surg. 1997;  123 77-80
    CrossrefPubMedGoogle Scholar
  • 11 Kapur T R, Bangash W. Tegmental and petromastoid defects in the temporal bone.  J Laryngol Otol. 1986;  100 1129-1132
    CrossrefPubMedGoogle Scholar
  • 12 Ahren C, Thulin C A. Fatal intracranial complications due to politzerization of the outer ear canal in otitis therapy, caused by intracranial temporal bone defects.  Sven Lakartidn. 1964;  61 2421-2437
    PubMedGoogle Scholar
  • 13 Kamerer D B, Caparosa R J. Temporal bone encephalocele: diagnosis and treatment.  Laryngoscope. 1982;  92 878-882
    PubMedGoogle Scholar
  • 14 Kaseff L G, Seidenwurm D J, Nieberding P H, Nissen A J, Remley K R, Dillon W. Magnetic resonance imaging of brain herniation into the middle ear.  Am J Otol. 1992;  13 74-77
    PubMedGoogle Scholar
  • 15 Mosnier I, Fiky L E, Shahidi A, Sterkers O. Brain herniation and chronic otitis media: diagnosis and surgical management.  Clin Otolaryngol Allied Sci. 2000;  25 385-391
    CrossrefPubMedGoogle Scholar
  • 16 Kaufman B, Yonas H, White R J, Miller C F. Acquired middle cranial fossa fistulas: normal pressure and nontraumatic in origin.  Neurosurgery. 1979;  5 466-472
    CrossrefPubMedGoogle Scholar
  • 17 Ommaya A K. Cerebrospinal fluid rhinorrhea.  Neurology. 1964;  14 106-113
    CrossrefPubMedGoogle Scholar
  • 18 Sckunecht H F, Gulya A J. Anatomy of the Temporal Bone with Surgical Implication. Philadelphia, PA; Lea & Febiger 1986: 125-126
    Google Scholar
  • 19 Gacek R R. Arachnoid granulation cerebrospinal fluid otorrhea.  Ann Otol Rhinol Laryngol. 1990;  99 854-862
    PubMedGoogle Scholar
  • 20 Gacek R R. Evaluation and management of temporal bone arachnoid granulations.  Arch Otolaryngol Head Neck Surg. 1992;  118 327-332
    CrossrefPubMedGoogle Scholar
  • 21 Lalwani A K. Temporal bone encephalocele. In: Jackler RK, Brackman DE Neurotology. St. Louis, MO; Mosby 2004: 1089-1095
    Google Scholar
  • 22 Lundy L B, Graham M D, Kartush J M, LaRouere M J. Temporal bone encephalocele and cerebrospinal fluid leaks.  Am J Otol. 1996;  17 461-469
    PubMedGoogle Scholar
  • 23 Kale S U, Pfleiderer A G, Cradwick J C. Bilateral defects of the tegmen tympani associated with brain and dural prolapse in a patient with pulsatile tinnitus.  J Laryngol Otol. 2000;  114 861-863
    PubMedGoogle Scholar
  • 24 Pappas Jr D G, Hoffman R A, Cohen N L, Pappas Sr D G. Spontaneous temporal bone cerebrospinal fluid leak.  Am J Otol. 1992;  13 534-539
    PubMedGoogle Scholar
  • 25 Sdano M T, Pensak M L. Temporal bone encephaloceles.  Curr Opin Otolaryngol Head Neck Surg. 2005;  13 287-289
    CrossrefPubMedGoogle Scholar
  • 26 Skedros D G, Cass S P, Hirsch B E, Kelly R H. Beta-2 transferrin assay in clinical management of cerebral spinal fluid and perilymphatic fluid leaks.  J Otolaryngol. 1993;  22 341-344
    PubMedGoogle Scholar
  • 27 Mafee M F, Kumar A, Yannias D A, Valvassori G E, Applebaum E L. Computed tomography of the middle ear in the evaluation of cholesteatomas and other soft tissue masses: comparison with pluridirectional tomography.  Radiology. 1983;  148 465-472
    PubMedGoogle Scholar
  • 28 Ishii K, Takahashi S, Matsumoto K et al.. Middle ear cholesteatoma extending into the petrous apex: evaluation by CT and MR imaging.  AJNR Am J Neuroradiol. 1991;  12 719-724
    PubMedGoogle Scholar
  • 29 Liu D P, Bergeron R T. Contemporary radiologic imaging in the evaluation of middle ear-attic-antral complex cholesteatomas.  Otolaryngol Clin North Am. 1989;  22 897-909
    PubMedGoogle Scholar
  • 30 Raine C. Diagnosis and management of otologic cerebrospinal fluid leak.  Otolaryngol Clin North Am. 2005;  38 583-595
    CrossrefPubMedGoogle Scholar
  • 31 Graham M D, Lundy L B. Dural herniation and cerebrospinal fluid leaks. In: Brackmann DE, Shelton C, Arriaga M Otologic Surgery. Philadelphia, PA; WB Saunders 1993: 277-288
    Google Scholar
  • 32 Glasscock III M E, Dickins J R, Jackson C G, Wiet R J, Feenstra L. Surgical management of brain tissue herniation into the middle ear and mastoid.  Laryngoscope. 1979;  89 1743-1754
    PubMedGoogle Scholar
  • 33 Jahrsdoerfer R A, Richtsmeier W J, Cantrell R W. Spontaneous CSF otorrhea.  Arch Otolaryngol. 1981;  107 257-261
    PubMedGoogle Scholar
  • 34 Ramsden R T, Latif A, Lye R H, Dutton J E. Endaural cerebral hernia.  J Laryngol Otol. 1985;  99 643-651
    PubMedGoogle Scholar
  • 35 Dedo G G, Sooy F A. Endaural encephalocele and cerebrospinal fluid otorrhea.  Ann Otol Rhinol Laryngol. 1970;  79 168-177
    PubMedGoogle Scholar
  • 36 Lalwani A K. Temporal bone encephalocele. In: Jackler RK, Brackman DE Neurotology. St. Louis, MO; Mosby 2004: 1089-1095
    Google Scholar
  • 37 Neely J G, Neblett C R, Rose J. Diagnosis and treatment of spontaneous cerebrospinal fluid otorrhea.  Laryngoscope. 1982;  92 609-612
    PubMedGoogle Scholar
  • 38 Wootten C T, Kaylie D M, Warren F M, Jackson C G. Management of brain herniation and cerebrospinal fluid leak in revision chronic ear surgery.  Laryngoscope. 2005;  115 1256-1261
    CrossrefPubMedGoogle Scholar
  • 39 Kuhweide R, Casselman J W. Spontaneous cerebrospinal fluid otorrhea from a tegmen defect: transmastoid repair with minicraniotomy.  Ann Otol Rhinol Laryngol. 1999;  108 653-658
    PubMedGoogle Scholar
  • 40 Valtonen H, Geyer C, Tarlov E, Heilman C, Poe D. Tegmental defects and cerebrospinal fluid otorrhea.  ORL J Otorhinolaryngol Relat Spec. 2001;  63 46-52
    PubMedGoogle Scholar
  • 41 Savva A, Taylor M J, Beatty C W. Management of cerebrospinal fluid leaks involving the temporal bone: report on 92 patients.  Laryngoscope. 2003;  113 50-56
    CrossrefPubMedGoogle Scholar
  • 42 Dandy W E. Treatment of rhinorrhea and otorrhea.  Arch Surg. 1944;  49 779-788
    PubMedGoogle Scholar
  • 43 Canfeield R B. Some conditions associated with the loss of cerebrospinal fluid.  Ann Otol Rhinol Laryngol. 1913;  22 604-622
    PubMedGoogle Scholar
  • 44 Paparella M M, Meyerhoff W L, Oliviera C A. Mastoiditis and brain hernia (mastoiditis cerebri).  Laryngoscope. 1978;  88 1097-1106
    PubMedGoogle Scholar
  • 45 Rathore M H. Do prophylactic antibiotics prevent meningitis after basilar skull fracture?.  Pediatr Infect Dis J. 1991;  10 87-88
    PubMedGoogle Scholar
  • 46 Friedman J A, Ebersold M, Quast L M. Post-traumatic cerebrospinal fluid leakage.  World J Surg. 2001;  25 1062-1066
    CrossrefPubMedGoogle Scholar
  • 47 Ignelzi R J, VanderArk G D. Analysis of the treatment of basilar skull fractures with and without antibiotics.  J Neurosurg. 1975;  43 721-726
    CrossrefPubMedGoogle Scholar
  • 48 Eljamel M S. Antibiotic prophylaxis in unrepaired CSF fistulae.  Br J Neurosurg. 1993;  7 501-505
    CrossrefPubMedGoogle Scholar

A. BibasM.Sc. 

2 Nikitara Street, 154 51 Athens

Greece

Email: thanosbibas@hotmail.com

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