Outcomes for Repair of Middle Cranial Fossa Encephaloceles Using Pedicled Temporalis Myofascial Flaps with Bone Grafts

Objectives: To determine whether our repair technique using pedicled temporalis myofascial flaps with bone grafts renders an advantage in outcomes in comparison to more frequently described techniques.

Design: Retrospective, single-center case series.

Participants: Patients who underwent surgical repair of middle fossa encephaloceles using a middle cranial fossa approach with pedicled temporalis myofascial flaps and bone grafts between 2017 and 2019.

Main Outcome Measures: Resolution of cerebrospinal fluid otorrhea, facial nerve outcomes, audiologic outcomes, postoperative temporomandibular joint and temporal pain, and complications.

Results: Thirty-eight patients were included in the study. All patients had middle cranial fossa approaches using anteriorly based pedicled temporalis myofascial flaps with split calvarial bone grafts to create a vascularized, multilayer dural closure. This is shown in the attached images. This has led to decreased temporomandibular joint and temporal pain compared with previous techniques used with an excellent success rate. There have been minimal complications to date.

Conclusion: The use of a pedicled temporalis flap creates a more durable repair while minimizing donor-site morbidity. We recommend this technique as an effective, efficient method to manage this pathology.

No conflict of interest has been declared by the author(s).