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Tegmental dehiscence and brain herniation into the middle ear cleft

Published online by Cambridge University Press:  29 June 2007

D. G. Golding-Wood ,
H. O. L. Williams  and
G. B. Brookes
D. G. Golding-Wood
Affiliation:
London
H. O. L. Williams
Affiliation:
London
G. B. Brookes*
Affiliation:
London
*
Mr Gerald B. Brookes, F.R.C.S., Royal National Throat Nose and Ear Hospital, Gray's Inn Road, London WC1X 8DA.
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Abstract

The tegmen tympani may occasionally be breached by herniation of the temporal lobe with or without dural cover. The clinical presentation may be obvious with CSF otorrhoea but less so with apparent middle ear effusion, CSF rhinnorrhoea, conductive hearing loss, recurrrent meningitis or intracranial sepsis. Diagnosis requires suspicion of the condition, which may be aided by radiological imaging. Surgical repair is to be recommended: various techniques are available but bone enveloped by fascia placed by subtemporal approach is preferred. The features of this problem are highlighted by four cases.

Keywords

Brain, herniationEar, middle
Type
Clinical Records
Information
The Journal of Laryngology & Otology , Volume 105 , Issue 6 , June 1991 , pp. 477 - 480
Copyright
Copyright © JLO (1984) Limited 1991

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References

Ahren, C., Thulen, C. A. (1965) Lethalintracranial complications following inflation in the external auditory canal in the treatment of serous otitis media and due to defects in the petrous bone. Acta Otolaryngologica, 60: 407–421.CrossRefGoogle Scholar
Alberti, P. W. R., Dawes, J. K. D. (1961) Cerebrospinalotorrhoea in chronic ear disease. Journal of Laryngology and Otology, 75: 123–135.CrossRefGoogle ScholarPubMed
Blatt, I. M. (1963) Surgical repair for cerebrospinal otorrhoea due to middle ear and mastoid disease. Laryngoscope, 73: 446–460.Google Scholar
Bowes, A. K., Wiet, R. J., Monsell, E. M., Hahn, Y. S., O'Connor, C. A. (1987) Brain herniation and space-occupying lesions eroding the tegmen tympani. Laryngoscope, 97: 1172–1175.Google Scholar
Cairns, H. W. B., Ashcroft, P., Hannah, R. (1940) Brain fungus. Journal of Neurology, Neurosurgery and Psychiatry, 3: 350–351.Google Scholar
Caboche, H. (1902) De la hernie cerebrale dansles interventions intracraniennes dirigees contre les otites moyennessuppurees. Annales des malades de I'oreille, de larynx, du nez et du pharynx, 28: 278–294.Google Scholar
Dandy, W. E. (1944) Treatment of rhinorrhea and otorrhea. Archives of Surgery, 49: 75–85.Google Scholar
Dedo, H. H., Sooy, F. A. (1970) Endaural brain hernia (encephalocele) diagnosis and treatment. Laryngoscope, 80: 1090–1099.Google Scholar
Ecker, A. (1947) Cerebrospinal rhinorrhea by way of the eustachian tube: report of cases with the dural defect in the middle or posterior fossa. Journal of Neurosurgery, 4: 177–178.CrossRefGoogle ScholarPubMed
Fairman, H. D., Brown, N. J., Hallpike, C. S. (1968) Air embolism as a complication of inflation ofthe tympanum through the external auditory meatus. Acta Otolaryngologica, 66: 65–71.CrossRefGoogle Scholar
Falconer, M. A., Russell, D. S. (1944) Experimental traumatic cerebral cysts in the rabbit. Journal Neurosurgery, 1: 182–189.Google Scholar
Fisnes, K. A. (1973) Lethal intracranial complication following air insufflation with a pneumatic otoscope. Acta Otolaryngologica, 75: 436–438.Google Scholar
Glasscock, M. E., Dickins, J. R. E., Jackson, C. G., Wiet, R. J., Feenstra, L. (1979) Surgical management of brain tissue herniation into the middle ear and mastoid. Laryngoscope, 89: 1743–1754.Google Scholar
Graham, M. D. (1982) Surgical management of dural and temporal lobe herniation into the radical mastoid cavity. Laryngoscope, 92: 329–331.CrossRefGoogle ScholarPubMed
Hall, C. (1939) Brain hernia: A post-operativeproblem in otology. Annals of Otology, Rhinology and Laryngology, 48: 291–310.CrossRefGoogle Scholar
Hall, G. M., Pulec, J. L., Hallberg, O. E. (1967) Persistent cerebrospinal fluid otorrhea. Archives of Otolaryngology, 86: 43–47.Google Scholar
Holbourn, A. H. S. (1944) The mechanics of trauma with special reference to herniation of cerebral tissue. Journal of Neurosurgery, 1: 190–200.Google Scholar
Jahn, A. F. (1981) Endaural brain hernia: Repair using conchal cartilage. Journal of Otolaryngology, 10: 471–475.Google Scholar
Kamerer, D. B., Caperosa, R. J. (1982) Temporal bone encephalocele–Diagnosis and treatment. Laryngoscope, 92: 878–882.CrossRefGoogle ScholarPubMed
Kapur, T. R., Bangash, W. (1986) Tegmental and petromastoid defects in the temporal bone. Journal of Laryngology and Otology, 100: 1129–1132.CrossRefGoogle ScholarPubMed
Kemink, J. L., Graham, M. D., Kartush, J. M. (1986) Spontaneous encephalocele of the temporal bone. Archives of Otolaryngology–Head and Neck Surgery, 112: 558–561.Google Scholar
Lang, E. R., Bucy, P. C. (1962) Cerebrospinal fluid otorrhea. Archives of Otolaryngology, 75: 415–418.Google Scholar
Lang, D. V. (1983) Macroscopic bony deficiency of the tegmen tympani in adult temporal bones. Journal of Laryngology and Otology, 97: 685–688.Google Scholar
Neely, J. G., Neblett, C. R., Rose, J. E. (1982) Diagnosis and treatment of spontaneous cerebrospinal fluid otorrhea. Laryngoscope, 92: 609–612.CrossRefGoogle ScholarPubMed
Paparella, M. M., Meyerhoff, W. L., Oliviera, C. A. (1978) Mastoiditis and brain hernia. Laryngoscope, 88: 1097–1106.CrossRefGoogle ScholarPubMed
Ramsden, R. T., Latif, A., Lye, R. H., Dutton, J. E. M. (1985) Endaural cerebral hernia. Journal of Laryngology and Otology, 99: 643–651.Google Scholar
Shreyer, W., Sprenger, W. (1927) Überbasale Cephalocelen. Zeitschrift für Hals-Nasen und Ohrenheilkunde, 17: 252–258.Google Scholar
Schurr, P. H. (1960) Endaural cerebral hernia. British Journal of Surgery, 47: 414–417.CrossRefGoogle ScholarPubMed
Stout, J. J., Trowbridge, W. V., Ruggles, R. L. (1969) Surgical repair of dural herniation into themastoid bowl. Archives of Otolaryngology, 89: 850–855.CrossRefGoogle ScholarPubMed
Wetmore, S. J., Herrmann, P., Fisch, U. (1987) Spontaneous cerebrospinal fluid otorrhea. American Journal of Otology, 8: 96–102.Google Scholar