Middle Fossa Meningoencephalocele with Cerebrospinal Fluid Otorrhea in a Pediatric Patient Following Mastoidectomy

Resumo

Introdução: A meningoencefalocele de fossa média é rara em populações pediátricas, apresentando-se tipicamente com otorreia de líquido cefalorraquidiano (LCR) e complicações associadas. Apresentamos uma paciente do sexo feminino de 12 anos de idade apresentou-se com otorreia clara persistente à direita e cefaleias pós-mastoidectomia por otite média crônica. As imagens (TC e RM) confirmaram meningoencefalocele de fossa média através de defeito no osso temporal. O reparo cirúrgico envolveu craniotomia de fossa média, ressecção microscópica do tecido herniado, reconstrução do defeito com enxerto ósseo autólogo e fechamento dural. No pós-operatório, o vazamento de LCR resolveu-se sem recorrência. Métodos: revisão sistemática foi realizada nas bases de dados PubMed e Embase (até março de 2025), visando casos de meningoencefalocele de fossa média com otorreia de LCR utilizando termos MeSH selecionados. Resultados: Oito estudos (13 pacientes) foram incluídos. As apresentações predominantes foram otorreia de LCR e perda auditiva. Os acessos transmastoideo e transmastoide-fossa média combinado foram os mais frequentes, demonstrando desfechos bem-sucedidos e baixas taxas de recorrência. Discussão: O manejo cirúrgico via craniotomia de fossa média ou abordagens combinadas resolve efetivamente os sintomas e previne complicações. Conclusão: O diagnóstico imediato e a intervenção cirúrgica são cruciais, especialmente em pacientes pediátricos pós-mastoidectomia, para mitigar complicações graves.

Palavras-chave

Otorreia de líquido cefalorraquidiano; Fossa Craniana Média; Craniotomia; Pediatria

Abstract

Middle fossa meningoencephalocele is rare in pediatric populations, typically presenting with cerebrospinal fluid (CSF) otorrhea and associated complications. A pediatric case post-mastoidectomy and a systematic literature review were presented.. A 12-yearold female presented with persistent clear right-sided otorrhea and headaches following mastoidectomy for chronic otitis media. Imaging (CT and MRI) confirmed a middle fossa meningoencephalocele through a temporal bone defect. Surgical repair involved middle fossa craniotomy, microscopic resection of herniated tissue, defect reconstruction with autologous bone graft, and dural closure. Postoperatively, CSF leakage resolved without recurrence. Methods: A systematic review was performed in PubMed and Embase databases (up to March 2025), targeting cases of middle fossa meningoencephalocele with CSF otorrhea using selected MeSH terms. Results: Eight studies (13 patients) were included. Predominant presentations were CSF otorrhea and hearing loss. The transmastoid and combined transmastoidmiddle fossa approaches were most frequent, both demonstrating successful outcomes and low recurrence rates. Discussion: Surgical management via middle fossa craniotomy or combined approaches effectively resolves symptoms and prevents complications. Conclusion:

Prompt diagnosis and surgical intervention are crucial, especially in pediatric patients post-mastoidectomy, to mitigate severe complications.

Keywords

Cerebrospinal fluid otorrhea; Cranial fossa, Middle; Craniotomy; Pediatrics

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