Management of Meningoencephalic Herniation of the Temporal Bone: Personal Experience and Literature Review

Objectives/Hypothesis: Temporal bone meningoencephalic herniation is a rare condition with potentially dangerous complications. The aim of this study is to analyze the pathogenesis, clinical presentation, surgical treatment, and postoeprative outcome of 133 cases of surgically confirmed temporal bone meningoencephalic herniations. A review of the literature is also presented. Study Design: Retrospective case series (quaternary referral otology and skull base center). Methods: This study is based on the analysis of the collected data of 133 cases of temporal bone meningoencephalic herniations surgically treated from 1984 to 2006. The follow-up ranged form 12 to 204 months with a mean of 38.4 months. Results: Meningoencephalic herniations were divided into four etiologic groups, spontaneous (24.8%), secondary to chronic otitis media (21.8%), latrogenic (45.9%), and posttraumatic, (7.5%). Different surgical techniques were used for treatment, transmastoid approach (27.8%), middle cranial fossa approach (27.8%) combined technique (transmastoid plus minicraniotomy 3%) and middle ear obliteration with blind sac closure of the external auditory canal (41.4%). Conclusions: Temporal bone meningoencephalic herniations are potentially life threatening, and surgery must take place expeditiously. The choice of the most appropriate surgical approach must be based on the localization and size of the herniated tissue, pre-operative auditory function, the presence of active infection, intraoperative cerebrospoinal fluid leak, and concomitant pathology.