This retrospective review of 34 patients undergoing repair of the temporal bone defect via the middle cranial fossa approach provides the author’s management strategy for two problems: superior semicircular canal dehiscence and tegmen defects. The incidence of both these pathologies is being increasingly diagnosed due to improved imaging as well lifestyle changes. The authors observed though, the two conditions present with completely different symptoms, they may co-exist in a large number of patients. They advocate a multidisciplinary approach with layered reconstruction of the defects to address both the pathologies at the same surgery. According to the authors, a lumbar drain is not routinely required except in patients with known idiopathic intracranial hypertension. This seems to be a reasonable strategy which is being favoured by many neurotologists and neurosurgeons today.