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6 months (BC 37.9, AM 59.2, CR 49.5). The difference in mean operative time amongst the groups was faster for patients using bone cement (BC 100.2 min, AM 182.8, CM 133.2; p 0.00001). BC, AM, and CM techniques each demonstrate effective and sustained means of repair for middle fossa CSF leak and encephalocele, even in the presence of multiple defects. Use of isolated BC offers a significant decrease in operative time with a noninferior outcome. Active CSF leak at the time of surgery is associated with increased risk of recurrence. B
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