Abstract

The development of Spontaneous cerebrospinal fluid (CSF) leakage has been related to various factors. It may occur in patients with normal Intracranial pressure (ICP) and in only a minority with elevated ICP. Meningo-encephaloceles (MEC) of the temporal bone are mostly as result of otologic surgery or head trauma. The spontaneous type of MEC is further very rare. We describe here a rare case of CSF rhinorrhea as a presenting symptom of Idiopathic intracranial hypertension (IIH). The site of leakage found to be at left Middle cranial fossa (MCF) “left tygmen tympani” which was associated with left temporal MEC and CSF leakage into middle ear space. This rare complication of IIH represents a difficult condition to deal with, in regard to its diagnosis and management and carries a serious sequalae if it is mismanaged. Diagnostic process and management outlines were addressed. Management of IIH plus surgical repair of the skull base defect with middle ear reconstruction were applied here. Surgically, we intervene through transmastoid approach with exploratory left modified radical mastoidectomy; which showed two big holes in tegmen tympani measured about 8 × 4 mm and 5 × 4 mm with herniated MEC. Cauterizations of the herniated cele then closure of the defects were applied. Followed by middle ear reconstruction. The bony defects closed in multi-layered fashion. We used temporalis fascia, tragal cartilage, perichondtrium, bone dust, bone wax (hydroxyapatite bone cement) and fibrin glue. The posterior wall of external auditory canal was reconstructed by helical cartilage.

Keywords: Middle cranial fossa defect; Tegmen tympani; Spontaneous CSF leak; Encephalocele; Idiopathic intracranial HTN; Surgical approaches