LAUSR

OBJECTIVE The middle fossa craniotomy for tegmen defect repair provides wide access. This approach often requires temporal lobe manipulation, lumbar drain placement, and longer recovery. We describe a keyhole middle fossa approach with a simple titanium skull base repair that allows for wide access with no temporal lobe manipulation and does not require lumbar drain placement, which allowed for a dramatic reduction in hospital length of stay. METHODS A retrospective review was performed on 14 consecutive patients with spontaneous CSF otorrhea. Each patient underwent a keyhole middle fossa approach followed by multilayer dural repair with titanium mesh "gull wing" skull base reconstruction. Postoperative measures included operative time, length of hospital stay, CSF leak recurrence, and surgical complications (seizures, hemorrhage, aphasia, infection). RESULTS The average age of the patients was 60.7 +/- 12.7 years old and average BMI was 32.8 +/- 7.9 kg/m2. Nine of the patients were female. The average operative time was 103 +/- 32.8 minutes. The average hospital LOS was 1.4 days. There were no cases of postoperative CSF otorrhea, meningitis, aphasia, or seizures. There were no recurrences over a mean follow up of 20.3 months (range: 5 - 48 months). CONCLUSIONS A minimally invasive keyhole middle fossa approach with a multilayer dural reconstruction including titanium mesh "gull wing" skull base repair provides a quick and effective treatment for a broad spectrum of tegmen defects and meningoencephaloceles. This exposure and reconstruction technique do not require the use of a lumbar drain and results in minimal hospitalization.