Extra-dural repair of symptomatic tegmen defects through mini-temporal craniotomy: Our institutional experience

Background: Tegmen tympani defects may arise from idiopathic, congenital, inflammatory, traumatic, or iatrogenic causes. Patients with persistent otorrhea are at greatest risk for meningitis, which can be morbid and often the initial presentation in patients. Temporal bone defects are commonly repaired through craniotomy, middle fossa or transmastoid approach. We present our experience repairing tegmen defects extra-durally through mini-temporal craniotomy with a combination of a pedicled temporalis fascia graft and split-thickness calvarial graft. Methods: This is a retrospective review of consecutive patients from 2023 to 2026 with symptomatic tegmen defects that underwent extra-dural repair through craniotomy at our institution. Intraoperative lumbar drain was placed for all patients to decrease intracranial pressure and assist in the extradural approach. All dehiscences were repaired utilizing a pedicled temporalis fascia graft and split-thickness calvarial bone graft. Results: Twenty-five patients, mean age of 59 years, who underwent 27 craniotomies for tegmen repair at our institution were identified from 2023 to 2026. One patient underwent bilateral procedures. Of the initial presenting symptoms, 76% of patients presented with symptoms of cerebrospinal fluid otorrhea, 16% meningitis, 16% hearing loss, 4% dizziness, and 4% tinnitus. Median hospital length of stay was 3 days, 30-day readmission rate was <10%, and median postoperative follow-up was 18 months. Conclusion: Symptomatic tegmen defects risk serious complications and warrant definitive surgical repair. We demonstrate the mini-temporal craniotomy extradural approach, with pedicled temporalis fascia graft as a practical and effective approach to repairing middle cranial fossa dehiscence.