Grinblat G, et al. - The clinical presentation, intra-operative findings, and surgical management in patients with meningo-encephalic-herniation (MEH) were determined. A key step that could be used in choosing the optimal surgical procedure was incorporating etiology into MEHs. If the objective was to perform definitive surgery, the use of middle-ear-obliteration (MEO) was recommended whenever needed. It was determined that transmastoid, middle-cranial-fossa-approach, combined, and MEO techniques served as the optimal surgical approaches.