Technical NoteEndoscopic Middle Cranial Fossa Reconstruction with a Subtemporal Keyhole
Section snippets
Case Description
A 57-year-old man developed severe meningitis with otorrhea and aural fullness. He had no history of head injury or otolaryngologic diseases, and his body mass index was 23.0 kg/m2, indicating that he was not obese. Computed tomography (CT) and 3-dimensional CT revealed effusion in the left tympanic cavity and mastoid air cells (Figure 2A). A group of small temporal bone defects, each with a diameter of approximately 2 mm, and slight pneumocephalus around the bone defects were seen on the
Discussion
Vascularized pedicle tissue has been recommended for skull base reconstruction because it significantly decreases the incidence of CSF leakage,1, 2, 8, 9 and the vascularized temporal muscle flap has been commonly used for MCF reconstruction.10, 11 Although a temporal muscle flap is effective to repair CSF leakage from the MCF, postoperative pain, mastication problems, trismus, and poor cosmetic results continue.11, 12 In addition, the massive and bulky temporal muscle cannot be passed through
Conclusions
An initial case of endoscopic MCF reconstruction by subtemporal keyhole surgery was described. The vascularized DTF flap was flexible, long, and large enough to overlay bone defects on the MCF, overcoming the problems related to temporal muscle. This endoscopic technique could be a valid alternative for MCF reconstruction.
Acknowledgments
The authors greatly appreciate the assistance of Professor Manfred Tschabitscher of Brescia University, Italy, for teaching the endoscopic anatomy related to this surgical technique, and Dr. Mika Komatsu of Ohta Neurosurgical Clinic, Japan, for cooperation with previous anatomic studies and cordial advice regarding this study.
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