Surgical Technique for Repair of Tegmen Dehiscence with Encephalocele: A Retrospective Study.

Background and Objectives: Tegmen dehiscence with encephalocele presents certain surgical challenges, necessitating innovative approaches to improve patient outcomes and minimize complications. Here we aim to evaluate the safety and efficacy of a novel middle cranial fossa craniotomy technique. Methods: Nineteen adult patients with radiographically confirmed tegmen dehiscence with encephalocele were included. Patients underwent a middle cranial fossa craniotomy technique for tegmen dehiscence repair, utilizing a split-thickness bone graft, pedicled pericranial flap, and hydroxyapatite for extradural repair and with an inlay graft for the intradural repair. The primary outcome measured was the major perioperative complications or need for revision surgery, while the secondary outcome measured was the resolution or improvement of preoperative symptoms associated with tegmen dehiscence. Results: Our series encompassed tegmen dehiscence repairs in 19 patients, with an average age at surgery of 51 years (range: 24-82 years). The average follow-up time was 8.80 months (range: 0.43-27.62 months). Patients commonly presented with symptoms such as hearing loss ( n  = 8), otorrhea ( n  = 8), fullness or ear pressure ( n  = 6), dizziness or imbalance ( n  = 6), or a history of meningitis ( n  = 4), among others. Postoperatively, symptoms resolved completely in 42% of patients ( n  = 8) and partially in 58% of patients ( n  = 11). Notably, no patients required revision surgery or developed new dehiscence in the follow-up period. Conclusion: Our middle cranial fossa craniotomy technique for tegmen dehiscence with encephalocele repair demonstrated promising postoperative outcomes, with complete or partial symptom resolution in all patients and no major complications. Our findings suggest that this technique is a safe and effective approach for tegmen dehiscence repair.