{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,11,9]],"date-time":"2026-11-09T10:24:50Z","timestamp":1794219890731,"version":"4.8.0"},"reference-count":31,"publisher":"Journal of Neurosurgery Publishing Group (JNSPG)","issue":"1","content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":[],"published-print":{"date-parts":[[2026,7,1]]},"abstract":"<jats:sec>\n                    <jats:title>OBJECTIVE<\/jats:title>\n                    <jats:p>Temporal bone dehiscence (TBD) can be asymptomatic or present complex symptoms depending on the location, integrity of the dura, and the tissue that is herniated. Common variations include tegmen dehiscence and superior semicircular canal dehiscence. Surgical treatment aims to repair communication between the middle\/internal ear, mastoid, and intracranial compartments. The aim of this study was to describe a novel multilayer reconstruction technique for TBD, including cadaveric dissection emphasizing relevant surgical anatomy, and to evaluate postoperative outcomes in patients treated via the middle cranial fossa (MCF) approach.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>METHODS<\/jats:title>\n                    <jats:p>Patients with TBD who underwent surgical repair through the MCF approach at a single institution between January 2016 and December 2023 were retrospectively analyzed.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>RESULTS<\/jats:title>\n                    <jats:p>Twenty-nine patients (23 female, mean age 54 years; 4 patients treated bilaterally) who underwent 33 TBD repairs via the MCF approach were included in this analysis. Preoperative symptoms included hearing loss (86.2%), CSF otorrhea (62.1%), aural fullness (44.8%), pulsatile tinnitus (44.8%), and dizziness\/vertigo (34.5%). Four patients had a prior idiopathic intracranial hypertension (IIH) diagnosis. A multilayer reconstruction technique was used based on requisite reconstructive needs. In 24 procedures, encephaloceles were removed and the dural defect was repaired. Subjective symptomatic improvement was observed in 28 patients (96.6%). After surgery, lumbar puncture identified 9 additional patients with IIH, allowing prompt treatment and reducing recurrence risk.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>CONCLUSIONS<\/jats:title>\n                    <jats:p>The MCF approach for TBD repair using a multilayer reconstruction technique yielded favorable outcomes, improving symptoms and reducing complications. Intracranial pressure should be monitored due to the potential association between TBD and IIH.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.3171\/2025.11.jns251633","type":"journal-article","created":{"date-parts":[[2026,4,17]],"date-time":"2026-04-17T16:11:30Z","timestamp":1776442290000},"page":"132-142","source":"Crossref","is-referenced-by-count":1,"title":["Multilayer reconstruction technique for temporal bone dehiscence: a single-center experience with cadaveric illustrations"],"prefix":"10.3171","volume":"145","author":[{"given":"Ludovica","family":"Pasquini","sequence":"first","affiliation":[{"name":"Department of Neurosurgery, The Ohio State University Wexner Medical Center, Columbus;"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Chandrima","family":"Biswas","sequence":"additional","affiliation":[{"name":"Department of Neurosurgery, The Ohio State University Wexner Medical Center, Columbus;"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Joshua","family":"Vignolles-Jeong","sequence":"additional","affiliation":[{"name":"The Ohio State University College of Medicine, Columbus; and"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Robert J.","family":"Macielak","sequence":"additional","affiliation":[{"name":"Department of Otolaryngology-Head and Neck Surgery, The Ohio State University Wexner Medical Center, Columbus, Ohio"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Kyle C.","family":"Wu","sequence":"additional","affiliation":[{"name":"Department of Neurosurgery, The Ohio State University Wexner Medical Center, Columbus;"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Oliver F.","family":"Adunka","sequence":"additional","affiliation":[{"name":"Department of Otolaryngology-Head and Neck Surgery, The Ohio State University Wexner Medical Center, Columbus, Ohio"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Daniel M.","family":"Prevedello","sequence":"additional","affiliation":[{"name":"Department of Neurosurgery, The Ohio State University Wexner Medical Center, Columbus;"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1754","reference":[{"issue":"6","key":"b1","series-title":"Eur Arch Otorhinolaryngol","first-page":"2899","article-title":"Dehiscence or thinning of bone overlying the superior semicircular canal in idiopathic intracranial hypertension","volume":"279","author":"Berkiten G","year":"2022","unstructured":"Berkiten G, G\u00fcrb\u00fcz D, Akan O,  Dehiscence or thinning of bone overlying the superior semicircular canal in idiopathic intracranial hypertension. 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Otol Neurotol. 2012;33(7):1245\u20131250. doi:10.1097\/MAO.0b013e3182634e27"},{"issue":"6","key":"b4","series-title":"Otolaryngol Head Neck Surg","first-page":"1120","article-title":"Superior semicircular canal dehiscence in patients with spontaneous cerebrospinal fluid otorrhea","volume":"147","author":"Allen KP","year":"2012","unstructured":"Allen KP, Perez CL, Isaacson B, Roland PS, Duong TT, Kutz JW. Superior semicircular canal dehiscence in patients with spontaneous cerebrospinal fluid otorrhea. Otolaryngol Head Neck Surg. 2012;147(6):1120\u20131124. doi:10.1177\/0194599812457545"},{"issue":"6","key":"b5","series-title":"Neurosurg Focus","first-page":"E6","article-title":"Surgical management of temporal meningoencephaloceles, cerebrospinal fluid leaks, and intracranial hypertension: treatment paradigm and outcomes","volume":"32","author":"Kenning TJ","year":"2012","unstructured":"Kenning TJ, Willcox TO, Artz GJ, Schiffmacher P, Farrell CJ, Evans JJ. Surgical management of temporal meningoencephaloceles, cerebrospinal fluid leaks, and intracranial hypertension: treatment paradigm and outcomes. Neurosurg Focus. 2012;32(6):E6. doi:10.3171\/2012.4.FOCUS1265"},{"issue":"3","key":"b6","series-title":"Arch Otolaryngol Head Neck Surg","first-page":"249","article-title":"Sound- and\/or pressure-induced vertigo due to bone dehiscence of the superior semicircular canal","volume":"124","author":"Minor LB","year":"1998","unstructured":"Minor LB, Solomon D, Zinreich JS, Zee DS. Sound- and\/or pressure-induced vertigo due to bone dehiscence of the superior semicircular canal. Arch Otolaryngol Head Neck Surg. 1998;124(3):249\u2013258. doi:10.1001\/archotol.124.3.249"},{"issue":"1","key":"b7","series-title":"Semin Neurol","first-page":"151","article-title":"Superior semicircular canal dehiscence syndrome","volume":"40","author":"Steenerson KK","year":"2020","unstructured":"Steenerson KK, Crane BT, Minor LB. 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