Patients with temporal bone encephalocele and cerebrospinal fluid leakage commonly present with persistent otorrhea and conductive hearing loss mimicking chronic middle ear disease, which likely contributes to a delay in diagnosis. There is a high prevalence of obesity among this patient population, which may play a role in the pathogenesis of primary and recurrent disease.

The risk of severe neurological complications following the herniation of intracranial contents through a tegmen tympani defect necessitates prompt recognition and appropriate management. CT and MR imaging allows for definitive diagnosis ¹⁾.

A middle fossa craniotomy or a combined mastoid-middle fossa approach incorporating a multilayer autologous tissue technique is a safe and reliable method of repair that may be particularly useful for large or multifocal defects, with adequate exposure of defects and support of intracranial contents.

Defect reconstruction using artificial titanium mesh should generally be avoided given increased risks of recurrence and postoperative meningitis ²⁾.

A patient was treated successfully via an intracranial approach. An enhanced layer-by-layer repair of the encephalocele and skull base deficit was achieved from intradurally to extradurally, using temporalis fascia, nasal septum cartilage, and artificial dural graft. After a 22-month follow-up period the patient remains symptom free and no recurrence is noted ³⁾.