Objective Spontaneous temporal encephaloceles (STEs) are increasingly recognized as sequelae of idiopathic intracranial hypertension (IIH), which in turn may further complicate their management. We endeavored to review the University of Pennsylvania institutional experience on operative management of STEs, with a focus on factors which may influence surgical outcomes, particularly IIH. Design Retrospective chart review over 9 years from 2013 to 2022. Setting Single-center, two-hospital, tertiary care, academic setting. Participants Patients undergoing middle cranial fossa (43.9%), transmastoid (44.9%), or combined (11.2%) approaches for repair of STEs during the study period (n = 107). Main Outcome Measures Postoperative complication rates, recurrence, and diagnosis of IIH. Results The majority of patients were female (64.5%), with a mean body mass index (BMI) of 37 kg/m2 and mean age of 57 years. Twelve patients (9%) represented reoperations after failed primary repairs. Fourteen percent of patients undergoing primary surgical repair of STE were diagnosed with IIH, compared with 42% of patients undergoing reoperations (p = 0.015). In addition, there was a significant difference in the average BMI of patients undergoing primary (36.4 kg/m2) versus revision surgery (40.9 kg/m2, p = 0.04). Half of those undergoing reoperation were placed on postoperative acetazolamide compared with 11% of patients undergoing primary operations. No patient experienced recurrent leak after reoperation. Conclusion Based on our institutional experience, elevated BMI and the presence of IIH are significant predictors of reoperation for STE. In our experience, acetazolamide is a common adjunct management strategy in addition to reoperation for patients with recurrent cerebrospinal fluid leak in the setting of STE.

中文翻译：

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特发性颅内高压与复发性脑脊液漏和自发性颞叶脑膨出的再次手术有关

目的 自发性颞叶脑膨出（STE）越来越被认为是特发性颅内高压（IIH）的后遗症，这反过来又可能使其治疗变得更加复杂。我们努力回顾宾夕法尼亚大学在 STE 手术管理方面的机构经验，重点关注可能影响手术结果的因素，特别是 IIH。设计从2013年到2022年9年的回顾性图表回顾。设置单中心、两医院、三级医疗、学术设置。参与者 在研究期间接受中颅窝 (43.9%)、经乳突 (44.9%) 或联合 (11.2%) 方法修复 STE 的患者 (n = 107)。主要结果指标 IIH 的术后并发症发生率、复发率和诊断。结果 大多数患者为女性（64.5%），平均体重指数（BMI）为37 kg/m2，平均年龄为57岁。12 名患者 (9%) 在初次修复失败后再次接受手术。接受 STE 初次手术修复的患者中有 14% 被诊断为 IIH，而接受再次手术的患者这一比例为 42% (p = 0.015)。此外，接受初次手术的患者的平均体重指数 (36.4 kg/m2) 与翻修手术的患者 (40.9 kg/m2，p = 0.04) 存在显着差异。接受再次手术的患者中有一半在术后接受了乙酰唑胺治疗，而接受初次手术的患者只有 11% 接受了术后乙酰唑胺治疗。再次手术后，没有患者出现再次漏气的情况。结论 根据我们的机构经验，BMI 升高和 IIH 的存在是 STE 再次手术的重要预测因素。根据我们的经验，乙酰唑胺是 STE 复发性脑脊液漏患者除再次手术之外的常见辅助治疗策略。