Spontaneous Temporal Pole Encephalocele Presenting with Epilepsy: Report of Two Cases

Shimada, Sohei; Kunii, Naoto; Kawai, Kensuke; Usami, Kenichi; Matsuo, Tetsuji; Uno, Takeshi; Koizumi, Tomoyuki; Saito, Nobuhito

doi:10.1016/j.wneu.2015.04.028

Cited by 17 publications

(19 citation statements)

References 20 publications

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“…This study emphasize, along with other two new studies, 13,14 the recent interest in small temporal encephaloceles as a significant cause of temporal lobe epilepsy in patients in whom MRI was read as normal or noninformative. In contrast with previous studies, [5][6][7][8][9][10][11][12][13][14] we have focused our study in patients with encephaloceles that are located at the tip of the temporal pole. Therefore, we were able to gather a homogenous cohort that potentially shared similar features, contributing to the identification of signs that distinguish from other temporal epilepsies.…”

Section: Discussionmentioning

confidence: 99%

“…In addition to other studies, [5][6][7][8][9][10][11][12][13][14] which mainly described the epilepsy found in patients with RFE, we also included patients with well-controlled epilepsy. In doing so we broaden the clinical spectrum associated to this type of lesion.…”

Section: Discussionmentioning

confidence: 99%

“…1 However, 20-30% patients evaluated for surgery have normal MRI studies [2][3][4] or subtle structural lesions that are easily overlooked if not guided by semiology. In this regard, small case-series [5][6][7][8][9][10][11][12] have previously emphasized that small temporal encephalocele could be an unrecognized cause of epilepsy. Two recent articles, 13,14 studying larger groups of patients, have provided further evidence about this pathology as a significant cause of temporal lobe epilepsy in patients in whom the MRI was read as normal or noninformative.…”

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confidence: 99%

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Small temporal pole encephalocele: A hidden cause of “normal” MRI temporal lobe epilepsy

et al. 2016

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SUMMARYObjective: Small temporal pole encephalocele (STPE) can be the pathologic substrate of epilepsy in a subgroup of patients with noninformative magnetic resonance imaging (MRI). Herein, we analyzed the clinical, neurophysiologic, and radiologic features of the epilepsy found in 22 patients with STPE, and the frequency of STPE in patients with refractory focal epilepsy (RFE). Methods: We performed an observational study of all patients with STPE identified at our epilepsy unit from January 2007 to December 2014. Cases were detected through a systematic search of our database of RFE patients evaluated for surgery, and a prospective collection of patients identified at the outpatient clinic. The RFE database was also employed to analyze the frequency of STPE among the different clinical subgroups. Results: We identified 22 patients with STPE (11 women), including 12 (4.0%) of 303 patients from the RFE database, and 10 from the outpatient clinic. The median age was 51.5 years (range 29-75) and the median age at seizure onset was 38.5 years (range 15-73). Typically, 12 (80%) of 15 patients with left STPE reported seizures with impairment of language. Among the RFE cases, STPE were found in 9.6% of patients with temporal lobe epilepsy (TLE), and in 0.5% of those with extra-TLE (p = 0.0001). STPEs were more frequent in TLE patients with an initial MRI study reported as normal (23.3%) than in those with MRI-visible lesions (1.4%; p = 0.0002). Stereo-electroencephalography was performed in four patients, confirming the localization of the epileptogenic zone at the temporal pole with late participation of the hippocampus. Long-term seizure control was achieved in four of five operated patients. Significance: STPE can be a hidden cause of TLE in a subgroup of patients with an initial report of "normal" MRI. Early identification of this lesion may help to select patients for presurgical evaluation and tailored resection.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

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confidence: 99%

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Small temporal pole encephalocele: A hidden cause of “normal” MRI temporal lobe epilepsy

et al. 2016

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“…Most of these lesions are due to congenital defects, although they can be acquired following trauma, surgery, or infection [ 1 , 2 ]. When associated with temporal lobe seizures, encephaloceles are associated with bony defects in the middle cranial fossa [ 3 , 4 ]. Associated defects have also been localized to the petrosal bone [ 5 , 6 ], cribriform plate [ 7 ], and diffusely throughout the skull.…”

Section: Introductionmentioning

confidence: 99%

Epilepsy Surgery for Skull-Base Temporal Lobe Encephaloceles: Should We Spare the Hippocampus from Resection?

et al. 2018

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The neurosurgical treatment of skull base temporal encephalocele for patients with epilepsy is variable. We describe two adult cases of temporal lobe epilepsy (TLE) with spheno-temporal encephalocele, currently seizure-free for more than two years after anterior temporal lobectomy (ATL) and lesionectomy sparing the hippocampus without long-term intracranial electroencephalogram (EEG) monitoring. Encephaloceles were detected by magnetic resonance imaging (MRI) and confirmed by maxillofacial head computed tomography (CT) scans. Seizures were captured by scalp video-EEG recording. One case underwent intraoperative electrocorticography (ECoG) with pathology demonstrating neuronal heterotopia. We propose that in some patients with skull base temporal encephaloceles, minimal surgical resection of herniated and adjacent temporal cortex (lesionectomy) is sufficient to render seizure freedom. In future cases, where an associated malformation of cortical development is suspected, newer techniques such as minimally invasive EEG monitoring with stereotactic-depth EEG electrodes should be considered to tailor the surrounding margins of the resected epileptogenic zone.

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“…[5][6][7][8][9][10][11][12] Since that time, a recent increase in cases of TEs in patients with refractory epilepsy has been observed. [13][14][15][16][17] The prevalence of TEs among the largest case series has been 2%-4% of drug-resistant patients referred for epilepsy surgery evaluation, and TEs have been present in nearly 10% of patients with refractory temporal lobe epilepsy (RTLE), which have also accounted for 10% of surgical resections at some institutions. 15,16 Furthermore, it has been previously reported that 16%-31% of pa-tients with RTLE do not have a clearly identified lesion on routine MR imaging, 18,19 and TEs have been observed more frequently in patients with RTLE who had previously normal MR imaging findings.…”

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confidence: 99%

Detection and Characteristics of Temporal Encephaloceles in Patients with Refractory Epilepsy

Campbell¹,

Hyer

Lauzon

et al. 2018

AJNR Am J Neuroradiol

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Spontaneous Temporal Pole Encephalocele Presenting with Epilepsy: Report of Two Cases

Cited by 17 publications

References 20 publications

Small temporal pole encephalocele: A hidden cause of “normal” MRI temporal lobe epilepsy

Small temporal pole encephalocele: A hidden cause of “normal” MRI temporal lobe epilepsy

Epilepsy Surgery for Skull-Base Temporal Lobe Encephaloceles: Should We Spare the Hippocampus from Resection?

Detection and Characteristics of Temporal Encephaloceles in Patients with Refractory Epilepsy

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