Middle cranial fossa approach for the repair of spontaneous cerebrospinal fluid otorrhoea using autologous bone pate

Tegmen plate defects causing cerebrospinal fluid (CSF) leaks and brain hern ias have conventionally been repaired using soft tissue grafts by a transma stoid approach. A review of the literature reveals that the results of tran smastoid repairs have been less than satisfactory. We present here four pat ients with spontaneous CSF otorrhoea who had tegmen defects repaired using the middle cranial fossa approach. An autologous bone pare slab mixed with fibrin glue with additional temporalis fascia reinforcement was used for th e repairs. All four patients had uneventful postoperative periods and have had no subsequent CSF leak (follow-up range: 1-3 years). We believe that th e middle cranial fossa approach is more effective than the transmastoid app roach for the repair of CSF leaks and brain hernias through tegmen plate de fects. An important additional benefit is hearing preservation. We also rec ommend the use of bone pate along with soft tissue for the repair in order to achieve a secure seal. Bone pate can effectively seal multiple defects i n the tegmen plate without any risk of migration.