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case_images: (A, C, E) Preoperative coronal computed tomographies (CTs) demonstrating multiple tegmen defects bilaterally. (B, D, F) Preoperative magnetic resonance imaging (MRI) demonstrating suspected right-sided encephaloceles through tegmen defects.
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case_images: Thin-cut computed tomography (CT) and magnetic resonance imaging (MRI) scans showed right-sided tegmen dehiscence (largest ~10 mm), encephaloceles along the middle cranial fossa, and mastoid effusions (representative images in Fig. 1 , with two also having tegmen thinning or small defects on the left without encephaloceles).
case_images: Representative views of intraoperative craniotomy (A), incision at closure (B), and postoperative three-dimensional computed tomography scan showing the right-sided craniotomy (C).
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case_images: Navigation based on MRI and CT was utilized to plan an approximately 3-cm curvilinear incision above the ear ( Fig. 2B ), for a planned 3 x 2 cm craniotomy centered along the petrous ridge. After making one small burr hole with an acorn bit, we turned the mini-craniotomy with a B1 footplate (see Fig. 2A for craniotomy in vivo and Fig. 2C for 3D-postoperative CT reconstruction).
case_images: Illustration of multilayered tegmen repair with both intradural (DuraGen inlay) and extradural (temporalis fascia graft, DuraGen onlay, fibrin sealant not pictured, and bone graft) components. (A) pre-repair, (B) multilayered tegmen repair, (C) multilayered tegmen repair with split-thickness bone graft placed. Created with BioRender.com.
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case_images: The whole repair area was then coated with a fibrin tissue sealant, with care to avoid transit into the middle or inner ear structures conceptualized in Fig. 3 . In one case with a larger bony defect, a split thickness bone graft from the craniotomy was also fashioned and placed over this reconstruction (conceptualized in Fig. 3 ).
case_images: (A) Three tegmen defects identified extradurally, prior to reduction of encephaloceles. (B) Visualization of vein of Labbe via keyhole craniotomy and dural inlay after completion of intradural portion, prior to watertight closure. (C) Fascial graft placed extradurally.
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case_images: With microscopic view shown in Fig. 4 .