title: Temporal Lobe Encephaloceles: A Potentially Curable Cause of Seizures.
abstract: OBJECTIVE
  Temporal lobe encephaloceles are characterized by protrusion of brain parenchyma through a structural defect in the floor of the middle fossa. They have been reported to cause cerebrospinal fluid (CSF) leaks, conductive hearing loss, meningitis, and seizures. The association between temporal encephaloceles and epileptiform activity is particularly rare.
  
  
  METHODS
  All patients who presented to a single tertiary referral center between 2011 and 2014 with intractable seizures and radiographic evidence of a middle cranial fossa encephalocele were evaluated. Five patients from this subset who underwent surgical repair of their encephalocele are presented.
  
  
  METHODS
  Middle cranial fossa approach for encephalocele repair.
  
  
  METHODS
  Postoperative epileptiform activity.
  
  
  RESULTS
  Five patients underwent a craniotomy for resection of a temporal lobe encephalocele with repair of a middle fossa floor defect. After surgery, CSF rhinorrhea resolved, when present, and all patients remained seizure-free through their last available follow-up. Range of follow-up time was 3.5 months to 4 years. Average follow-up time was 19.7 months.
  
  
  CONCLUSIONS
  Temporal lobe encephaloceles are an infrequent cause of seizures. Given that these lesions can be missed with standard imaging modalities, they are likely underdiagnosed upon initial medical evaluation. This diagnosis should be considered in patients with intractable seizures. If an encephalocele is found, focused resection of epileptogenic tissue associated with herniation and repair of the temporal floor defect can provide definitive treatment.
authors.affiliation: *Departments of Neurological Surgery, †Otolaryngology-Head and Neck Surgery, and ‡Neurology, Vanderbilt University Medical Center, Nashville, Tennessee, U.S.A.
authors.forename: Peter J
authors.initials: PJ
authors.lastname: Morone
authors.forename: Alex D
authors.initials: AD
authors.lastname: Sweeney
authors.forename: Matthew L
authors.initials: ML
authors.lastname: Carlson
authors.forename: Joseph S
authors.initials: JS
authors.lastname: Neimat
authors.forename: Kyle D
authors.initials: KD
authors.lastname: Weaver
authors.forename: Bassel W
authors.initials: BW
authors.lastname: Abou-Khalil
authors.forename: Amir M
authors.initials: AM
authors.lastname: Arain
authors.forename: Pradumna
authors.initials: P
authors.lastname: Singh
authors.forename: George B
authors.initials: GB
authors.lastname: Wanna
mesh_terms: D000328:Adult; D002559:Cerebrospinal Fluid Rhinorrhea / Q000209:etiology / Q000601:surgery; D015331:Cohort Studies; D035301:Cranial Fossa, Middle / Q000601:surgery*; D003399:Craniotomy / Q000379:methods; D000069279:Drug Resistant Epilepsy / Q000209:etiology / Q000601:surgery*; D004677:Encephalocele / Q000150:complications / Q000601:surgery*; D004833:Epilepsy, Temporal Lobe / Q000601:surgery*; D005260:Female; D006801:Humans; D008297:Male; D008581:Meningitis / Q000209:etiology / Q000601:surgery; D008875:Middle Aged; D012189:Retrospective Studies; D012640:Seizures / Q000209:etiology / Q000601:surgery*; D013702:Temporal Lobe / Q000601:surgery*; D016896:Treatment Outcome