{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,2,19]],"date-time":"2026-02-19T00:22:17Z","timestamp":1771460537332,"version":"3.50.1"},"reference-count":17,"publisher":"Georg Thieme Verlag KG","issue":"01","license":[{"start":{"date-parts":[[2025,1,13]],"date-time":"2025-01-13T00:00:00Z","timestamp":1736726400000},"content-version":"vor","delay-in-days":12,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["J Neurol Surg Rep"],"published-print":{"date-parts":[[2025,1]]},"abstract":"<jats:title>Abstract<\/jats:title><jats:p>\n          Background and Importance\u2003Tegmen defects associated with cerebrospinal fluid (CSF) leaks are a rare pathology that can result in severe complications if left untreated. There is no universal optimal surgical algorithm for repair, although the most common techniques are the middle fossa craniotomy (traditionally 25\u2009cm2 in area), the transmastoid approach, or both. Here, we describe successful use of a keyhole mini-craniotomy, only 6\u2009cm2 in area, without mastoidectomy or days of lumbar drainage.<\/jats:p><jats:p>\n          Clinical Presentation\u2003Three patients presented with right-sided CSF otorrhea and hearing loss, with varying sizes of tegmen defects and associated encephaloceles. Keyhole craniotomies measuring 3\u2009\u00d7\u20092\u2009cm were used to perform a multilayer repair comprising an intradural collagen dural substitute, extradural fascial graft, extradural collagen dural substitute, fibrin sealant, and sometimes bony reconstruction using partial thickness craniotomy grafting. All patients were discharged on postoperative day 1 or 2, with no recurrence of symptoms at 6 months.<\/jats:p><jats:p>\n          Conclusion\u2003The keyhole craniotomy approach does not sacrifice the extent of operative access for this pathology. This minimally invasive approach can likely be used more often without need for concomitant mastoidectomy, ultimately enabling shorter hospital stays and more rapid recovery.<\/jats:p>","DOI":"10.1055\/a-2514-7338","type":"journal-article","created":{"date-parts":[[2025,1,13]],"date-time":"2025-01-13T23:52:58Z","timestamp":1736812378000},"page":"e19-e23","source":"Crossref","is-referenced-by-count":1,"title":["Keyhole Mini-Craniotomy Middle Fossa Approach for Tegmen Repair: A Case Series and Technical Instruction"],"prefix":"10.1055","volume":"86","author":[{"given":"Syed M.","family":"Adil","sequence":"additional","affiliation":[{"name":"Department of Neurosurgery, Duke University Medical Center, Durham, North Carolina, United States"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-3129-1133","authenticated-orcid":false,"given":"Tanner J.","family":"Zachem","sequence":"additional","affiliation":[{"name":"Department of Neurosurgery, Duke University Medical Center, Durham, North Carolina, United States"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Jordan K.","family":"Hatfield","sequence":"additional","affiliation":[{"name":"Department of Neurosurgery, Duke University Medical Center, Durham, North Carolina, United States"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Jihad","family":"Abdelgadir","sequence":"additional","affiliation":[{"name":"Department of Neurosurgery, Duke University Medical Center, Durham, North Carolina, United States"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Kimberly","family":"Hoang","sequence":"additional","affiliation":[{"name":"Department of Neurosurgery, Emory University School of Medicine, Atlanta, Georgia, United States"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Patrick J.","family":"Codd","sequence":"additional","affiliation":[{"name":"Department of Neurosurgery, Duke University Medical Center, Durham, North Carolina, United States"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"194","published-online":{"date-parts":[[2025,2,10]]},"reference":[{"issue":"06","key":"ref1","doi-asserted-by":"crossref","first-page":"E6","DOI":"10.3171\/2012.4.FOCUS1265","article-title":"Surgical management of temporal meningoencephaloceles, cerebrospinal fluid leaks, and intracranial hypertension: treatment paradigm and outcomes","volume":"32","author":"T J Kenning","year":"2012","journal-title":"Neurosurg Focus"},{"issue":"09","key":"ref2","doi-asserted-by":"crossref","first-page":"2427","DOI":"10.1007\/s00405-012-2260-8","article-title":"Management of iatrogenic tegmen plate defects: our clinical experience and surgical technique","volume":"270","author":"H Wahba","year":"2013","journal-title":"Eur Arch Otorhinolaryngol"},{"issue":"02","key":"ref3","doi-asserted-by":"crossref","first-page":"103","DOI":"10.1055\/s-0033-1333616","article-title":"Cerebrospinal fluid leakage from tegmen tympani 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Neurosurg"},{"issue":"01","key":"ref10","doi-asserted-by":"crossref","first-page":"102794","DOI":"10.1016\/j.amjoto.2020.102794","article-title":"Outcomes after mini-craniotomy middle fossa approach combined with mastoidectomy for lateral skull base defects","volume":"42","author":"A Walia","year":"2021","journal-title":"Am J Otolaryngol"},{"issue":"03","key":"ref11","doi-asserted-by":"crossref","first-page":"268","DOI":"10.1055\/s-0039-1688793","article-title":"Middle cranial fossa encephalocele and cerebrospinal fluid leakage: etiology, approach, outcomes","volume":"81","author":"B McNulty","year":"2020","journal-title":"J Neurol Surg B Skull Base"},{"issue":"08","key":"ref12","doi-asserted-by":"crossref","first-page":"1026","DOI":"10.1097\/MAO.0000000000002302","article-title":"Audiologic improvement following MCF approach for spontaneous cerebrospinal fluid leaks","volume":"40","author":"M Alwani","year":"2019","journal-title":"Otol Neurotol"},{"issue":"10","key":"ref13","doi-asserted-by":"crossref","first-page":"1625","DOI":"10.1097\/MAO.0000000000001208","article-title":"Middle cranial fossa (MCF) approach without the use of lumbar drain for the management of spontaneous cerebral spinal fluid (CSF) leaks","volume":"37","author":"R F Nelson","year":"2016","journal-title":"Otol Neurotol"},{"issue":"01","key":"ref14","doi-asserted-by":"crossref","first-page":"41","DOI":"10.1007\/s10143-023-01947-z","article-title":"Surgical management of spontaneous middle cranial fossa defects: a systematic review and meta-analysis of available reconstructive techniques and materials","volume":"46","author":"E Porto","year":"2023","journal-title":"Neurosurg Rev"},{"issue":"04","key":"ref15","doi-asserted-by":"crossref","first-page":"102560","DOI":"10.1016\/j.amjoto.2020.102560","article-title":"Surgical management of middle cranial fossa bone defects: meningoencephalic herniation and cerebrospinal fluid 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