{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2025,10,20]],"date-time":"2025-10-20T18:34:06Z","timestamp":1760985246584},"reference-count":21,"publisher":"Journal of Neurosurgery Publishing Group (JNSPG)","issue":"3","content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["JNS"],"published-print":{"date-parts":[[2015,3]]},"abstract":"\nOBJECT<\/jats:title>\nMiddle fossa floor dehiscence (MFFD) can present as multiple syndromes depending on dehiscence location, tissue herniation, and dural integrity. The authors propose a classification system for MFFD with the potential to guide clinical decision making.<\/jats:p><\/jats:sec>\n\nMETHODS<\/jats:title>\nA retrospective analysis of the electronic medical records (years 1995\u20132012) of patients who had undergone temporal craniotomy for the surgical repair of an MFFD syndrome at a single institution was undertaken. Reviewed data included demographic, operative, presentation, and outcome details. Middle fossa floor dehiscence was classified as follows: Class A, bony dehiscence without herniation of the brain and\/or meninges; Class B, herniation of the brain and\/or meninges through the middle fossa floor without CSF leakage; Class C, dehiscence with CSF leakage without meningitis; or Class D, dehiscence with meningitis.<\/jats:p><\/jats:sec>\n\nRESULTS<\/jats:title>\nFifty-one patients, 22 males and 29 females, were included in the analysis. The mean age was 48.7 \u00b1 15.5 years, mean body mass index was 32.65 \u00b1 6.86 kg\/m2<\/jats:sup>, and mean symptom duration was 33 \u00b1 42 months. Seven patients underwent repeat surgery for symptomatic recurrence; therefore, there were 58 surgical encounters. Repair included bony reconstruction with hydroxyapatite with or without resection of encephaloceles and\/or repair of a dural defect. According to the MFFD classification system described, 15, 8, 27, and 8 cases were categorized as Class A, B, C, and D, respectively. The prevalence of hearing loss was 87%, 63%, and 70% in Classes A, B, and C, respectively. Vestibular symptoms were more prevalent in Class A. Seven patients reported persistent symptoms at the last follow-up. Transient complications were similar in each classification (13%\u201325%), and a single permanent complication related to anesthesia was observed. There were no mortalities or severe neurological morbidities in the series.<\/jats:p><\/jats:sec>\n\nCONCLUSIONS<\/jats:title>\nMiddle fossa floor dehiscence has a spectrum of clinical presentations. A classification system may help to clarify the diagnosis and guide therapy. Surgery, the mainstay of treatment, is safe and well tolerated.<\/jats:p><\/jats:sec>","DOI":"10.3171\/2014.11.jns132798","type":"journal-article","created":{"date-parts":[[2015,1,2]],"date-time":"2015-01-02T15:02:11Z","timestamp":1420210931000},"page":"557-563","source":"Crossref","is-referenced-by-count":8,"title":["Classification of middle fossa floor dehiscence syndromes"],"prefix":"10.3171","volume":"122","author":[{"given":"Kunal","family":"Gupta","sequence":"first","affiliation":[{"name":"Department of Neurological Surgery, Oregon Health & Science University, Portland, Oregon;"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Hatem A.","family":"Sabry","sequence":"additional","affiliation":[{"name":"Department of Neurological Surgery, Oregon Health & Science University, Portland, Oregon;"},{"name":"Department of Neurological Surgery, Ain Shams University, Cairo, Egypt;"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Aclan","family":"Dogan","sequence":"additional","affiliation":[{"name":"Department of Neurological Surgery, Oregon Health & Science University, Portland, Oregon;"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Nicholas D.","family":"Coppa","sequence":"additional","affiliation":[{"name":"Department of Neurological Surgery, Oregon Health & Science University, Portland, Oregon;"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Sean","family":"McMenomey","sequence":"additional","affiliation":[{"name":"Department of Otolaryngology, New York University, New York, New York; and"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Johnny B.","family":"Delashaw","sequence":"additional","affiliation":[{"name":"Neurosurgery, Neuroscience Institute, Swedish Medical Center, Seattle, Washington"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Ahmed M.","family":"Raslan","sequence":"additional","affiliation":[{"name":"Department of Neurological Surgery, Oregon Health & Science University, Portland, Oregon;"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"1754","reference":[{"key":"b1-jns132798","series-title":"Arch Otolaryngol Head Neck Surg","doi-asserted-by":"publisher","first-page":"471","DOI":"10.1001\/archoto.2012.614","article-title":"Treatment strategies for lateral sphenoid sinus recess cerebrospinal fluid leaks","volume":"138","author":"Alexander","year":"2012"},{"key":"b2-jns132798","series-title":"Neurol Med Chir (Tokyo)","doi-asserted-by":"publisher","first-page":"243","DOI":"10.2176\/nmc.50.243","article-title":"Spontaneous cerebrospinal fluid rhinorrhea associated with a far lateral temporal encephalocele\u2014case report","volume":"50","author":"Arai","year":"2010"},{"key":"b3-jns132798","series-title":"Clin Otolaryngol Allied Sci","doi-asserted-by":"publisher","first-page":"117","DOI":"10.1046\/j.1365-2273.2001.00438.x","article-title":"Middle cranial fossa approach for the repair of spontaneous cerebrospinal fluid otorrhoea using autologous bone pate","volume":"26","author":"Dutt","year":"2001"},{"key":"b4-jns132798","series-title":"Trans Am Laryngol Rhinol Otol Soc","first-page":"381","article-title":"Spontaneous cerebrospinal otorrhea. 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