Endoscopic Repair of Lateral Skull Base Defect by Multiple Layers Graft: A Case of Post Traumatic Left Middle Ear Meningocele

By June 7, 2019

Eid, Waleed1
1 ORL-Head and Neck Surgery, Faculty of Medicine, Mansoura University, Egypt.

The lateral skull base defects either congenital dehescnce or post-traumtic could be serious conditions. The similar anterior skull base defects are nawadays effeciently managed endoscopically transnasal by our rhinologist colleagues. The question is could the former lateral skull base defects managed endoscopically via transcanal as the ant skull base ones?

The video demonstrates the endoscopic management of a lateral skull base defect (dehescent tegmen) with left post traumatic middle ear meningocele.
Male patient, 41 years old with history of head trauma 9 month ago followed by CSF otorrhea with pin hole perforation healed spontaneously within 5 months. Then, he complained of hearing loss and pulsatile tinnitus. No past history of neither otological nor neurological manifestations before trauma.
CT and MRI revealed the presence of left middle ear meningocele. Transcanal endoscopic removal of the meningocele was performed with repair of the defect by usin temporalis fascia, platelet rich plasma and cartilage. Ossicular reconstraction by refashioned incus between the malleus and sealed footplate.

Depending on the same concept of repairing the anterior skull base defects dy multiple layers grafting, we used the same technique in repairing the lateral skull base defects with minimal morbidity.

The lateral skull base defects could be managed endoscopically via the minimal morbdity transcanal apprroach with excellent results.