Neurotologic manifestations and treatment of multiple spontaneous tegmental defects

Objective: To describe the causes, histopathologic features. manifestations . and treatment of symptomatic multiple spontaneous tegmental defects. Study Design: Retrospective review of three clinical cases and one temporal bone histopathology report. Clinical Features: Varied, including spontaneous cerebrospinal fluid otorhi norrhea. conductive hearing loss, chronic headaches, pneumocephalus, extrad ural abscess, and meningitis. A notable common feature was multiple (8-15) tegmental defects, 1 to 6 millimeters in diameter, Three of the four cases also included associated dural defects and small meningoencephaloceles or a rachnoid granulations, imaging studies generally underestimated the number of defects. Intervention and Outcomes: Successful middle cranial fossa repair with temp oralis fascia wets accomplished in the three clinical cases. Extension of e xposure anteriorly and medially was necessary. Closure of the defects with a bone graft or equivalent synthetic material was not always possible, give n the anatomic and pathologic features. Our data suggest that there are bot h congenital and acquired causes of the tegmental dehiscences. Conclusions: Multiple tegmen defects constitute a special entity. Successfu l repair requires a middle fossa craniotomy with extended exposure.