Upfront use of temporal myofascial flap for repair of traumatic injury and prevention of CSF leaks: illustrative cases

BACKGROUND Traumatic brain injury involving destruction of the mastoid bone leading to a large defect in the middle fossa floor or posterior fossa dura can necessitate delayed or multistep repairs or reconstruction of the middle fossa floor because of a CSF leak and rhinorrhea. Delayed repair may be associated with CNS infection. Reconstruction using a temporalis myofascial flap has been described in delayed reconstruction cases with CSF leak. The authors report a novel concept of upfront repair. OBSERVATIONS Two patients with gunshot wound injuries involving the mastoid and middle fossa floor or posterior fossa dura underwent decompression and simultaneous early reconstruction with a temporalis myofascial flap sutured to the middle fossa dura. Both patients avoided prolonged CSF leak and had no complications from this approach. LESSONS Upfront repair of traumatic defects of the middle fossa floor or posterior fossa dura involving the mastoid air cells may avoid a prolonged CSF leak and its complications. https://thejns.org/doi/10.3171/CASE25412