We report a case of the temporal encephalocele with severe middle ear infection.
A 35-year-old woman was diagnosed with chronic otitis media (CT scan in 2000 showed no specific findings), and had a history of purulent otorrhea and the appearance of severe granulation in 2004.A bony defect of the tegmen tympani was demonstrated on 3D-CT scan of the temporal bone, and the signal from the region extruded through the bony defect was continuous with that of intracranial tissue on sagittal plane MRI. On pathogenic examinations, cortical neural tissue surrounded by granulation was diagnosed.
As the middle ear infection was intractable to all preoperative treatment, the patient underwent a 2-staged and combined approach in order to minimize the surgical risk. In the first stage of surgery via the middle fossa, the herniated brain tissue was amputated without opening the middle ear cavity. The bone defect was repaired using a three-layer graft (periosteum-free bone-periosteum) and a temporalis fascia flap extradurally.In the second stage via a transmastoidal approach, amputated brain tissue with granulation that filled the mastoid cavity was removed and the bone defect was covered with a periosteal flap at the side of the mastoid cavity. There was no further otorrhea or CSF leakage postoperatively.
Each of the three surgical approaches has a specific advantage, and generally, the preferred surgical approach is determined by the position, size and presence of infection. When infection in the middle ear cannot be controlled as in the present case, 2-staged and combined surgery is one of the surgical options for reducing the intra cranial infection.
