BRAIN HERNIATION INTO THE MIDDLE-EAR AND MASTOID - CONCEPTS IN DIAGNOSIS AND SURGICAL-MANAGEMENT

Objective: To review the occurrence characteristics of and clinical re pair experience with brain herniation in to the middle ear and mastoid from 1970-1995.Study Design: Retrospective chart/case review. Setting : Private Otology/Neurotology referral practice. Patients: Thirty-five patients with temporal bone brain herniation diagnosed and treated fr om 1970-1995. Intervention: Diagnosis confirmed by CT and/or MRI. Trea tment was surgical. Main Outcome Measures: Success of surgical repair of the problem in a large experience with follow-up of up to 180 month s (mean, 48.7 months). Results: Diagnosis is most effectively made by both (computed tomography (CT) and magnetic resonance imaging (MRI). I n this series diagnosis was accurate in 89% with MRI. Primary repair w as successful in all but three patients, two of whom required a second repair. One was unreconstructable. Conclusions: Temporal bone encepha loceles occur after ear surgery and in chronic otitis media. Prompt an d effective surgical repair is successful and integral to complication avoidance.