combined approach for giant temporal meningoencephalocele

Introduction:to present a complex case of giant meningoencephalocele after a canal wall down mastoidectomy and describe our preferred approach to repair meningoencephalic herniation of the temporal bone.case report:a 20-year-old patient, who had previously undergone type iii tympanoplasty with total ossicular reconstruction prosthesis for an attic cholesteatoma, presents with clinical and imaging features compatible with the diagnosis of a giant temporal meningoencephalocele. we performed a combined approach –transmastoid plus minicraniotomy- to repair the skull base defect. a multilayer reconstruction of the defect with septal cartilage and temporal fascia was performed. after a 48 months follow-up, the patient remains symptom free without signs of tissue herniation.conclusions:transmastoid plus minicraniotomy combined approach is a safe and feasible technique in case of large and anterior skull base defects with low surgical morbidity, allowing a safe and multilayered reconstruction, even in the context of a simultaneous active chronic otitis media.