Cosmetic mastoidectomy for the combined supra/infratentorial transtemporal approach

The authors describe a cosmetic mastoidectomy technique for use when performing a combined supra/ infratentorial craniotomy and transtemporal exposure. The technique involves a single temporal suboccipital bone flap and cosmetic mastoidectomy, removing the outer table of bone for later replacement. Replacement of the outer table of mastoid bone enables tamponade of a fat graft against the dura to reduce the risk of postoperative cerebrospinal fluid leaks. The technique has been performed in eight patients treated for petrocliva[ meningiomas with excellent cosmetic results.