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Increasing numbers of cases of idiopathic cerebrospinal fluid (CSF) leakage through temporal bone defects (TBD) have been recently reported, mainly in otolaryngologic journals. Those cases are referred to as spontaneous temporal bone encephaloceles (TBE). Three surgical approaches have been advocated for this condition: the transmastoid approach (TMA), the middle cranial fossa approach (MCFA), or a combination of both. We conducted a retrospective study of all 11 consecutive patients who underwent 12 middle cranial fossa craniotomies for the treatment of CSF leakage through TBD in our institution between 2011 and 2014. Neurosurgical and otologic data were collected from the patients’ records. Nine of our cases had an idiopathic etiology. No CSF leaks recurred during an average follow-up of 19.5 months. There was one case of a postoperative expressive aphasia with complete recovery in …