Claudio Carnevale - Department of ENT and Head and Neck, Hospital University Son Espases, Palma de Mallorca, Spain and Department of ENT and Head and Neck, Rotger Clinic, Palma de Mallorca, Spain.
Miguel Garcia-Wagner - Department of ENT and Head and Neck, Hospital University Son Espases, Palma de Mallorca, Spain.
Carolina Morales-Olavarría - Department of ENT and Head and Neck, Hospital University Son Espases, Palma de Mallorca, Spain.
Pedro Sarría-Echegaray - Department of ENT and Head and Neck, Hospital University Son Espases, Palma de Mallorca, Spain and Department of ENT and Head and Neck, Rotger Clinic, Palma de Mallorca, Spain.
Guillermo Til-Pérez - Department of ENT and Head and Neck, Hospital University Son Espases, Palma de Mallorca, Spain and Department of ENT and Head and Neck, Rotger Clinic, Palma de Mallorca, Spain.

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 ۲۰-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 ۴۸ 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.

Acquired Encephalocele, Cholesteatoma, Middle Ear, Temporal bone, Skull base