Middle fossa approach for spontaneous cerebrospinal fluid fistula and encephaloceles

Anthony M. Tolisano, Joe Walter Kutz

Research output: Contribution to journalReview articlepeer-review

4 Scopus citations


Purpose of reviewThe aim of this article is to describe the middle fossa craniotomy (MFC) approach for the repair of cerebrospinal (CSF) fistula and encephaloceles.Recent findingsThe MFC approach has a greater than 93% success rate for managing CSF fistula and encephaloceles located along the tegmen tympani and tegmen mastoideum. Posterior fossa defects cannot be managed by an MFC approach. Multilayer repair with the combination of soft tissue and durable substances is preferred. Hydroxyapatite bone cement provides a durable repair of thinned or absent areas of bone with a low risk of infection. Concurrent management of symptomatic superior semicircular canal dehiscence may be readily performed. Small keyhole craniotomies with the utilization of the endoscope are possible as a means to minimize temporal lobe retraction.SummaryMFC repair of CSF fistula and encephaloceles is a highly effective approach for the repair of tegmen mastoideum and tegmen tympani defects.

Original languageEnglish (US)
Pages (from-to)356-360
Number of pages5
JournalCurrent Opinion in Otolaryngology and Head and Neck Surgery
Issue number5
StatePublished - Oct 1 2019


  • cerebrospinal fluid fistula
  • encephalocele
  • hydroxyapatite bone cement
  • middle fossa craniotomy

ASJC Scopus subject areas

  • Surgery
  • Otorhinolaryngology


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