Taavi Saavalainen1, Leena Jutila1, Esa Mervaala1, Reetta Kälviäinen1, Ritva Vanninen2, Arto Immonen1. 1. From the Departments of Clinical Radiology (T.S., R.V.), Neurology (L.J., R.K.), Clinical Neurophysiology (E.M.), and Neurosurgery (A.I.), Kuopio University Hospital, Finland; and the Institute of Clinical Medicine (T.S., E.M., R.K., R.V.), University of Eastern Finland, Kuopio. 2. From the Departments of Clinical Radiology (T.S., R.V.), Neurology (L.J., R.K.), Clinical Neurophysiology (E.M.), and Neurosurgery (A.I.), Kuopio University Hospital, Finland; and the Institute of Clinical Medicine (T.S., E.M., R.K., R.V.), University of Eastern Finland, Kuopio. ritva.vanninen@kuh.fi.
Abstract
OBJECTIVE: To report the increasing frequency with which temporal anteroinferior encephalocele is a cause of adult temporal lobe epilepsy, to illustrate the clinical and imaging characteristics of this condition, and to report its surgical treatment in a series of 23 adult patients. METHODS: Epilepsy patients diagnosed with temporal anteroinferior encephalocele from January 2006 to December 2013 in a national epilepsy reference center were included in this noninterventional study. RESULTS: Twenty-three epilepsy patients (14 female, mean age 43.8 years) were diagnosed with temporal anteroinferior encephalocele in our institute. Thirteen patients had ≥2 encephaloceles; 7 cases presented bilaterally. The estimated frequency of this condition was 0.3% among MRI examinations performed due to newly diagnosed epilepsy (n = 6) and 1.9% among drug-resistant patients referred to our center (n = 17). Nine patients with local encephalocele disconnection (n = 4) or anterior temporal lobectomy and amygdalohippocampectomy (n = 5) have become seizure-free (Engel 1) for a mean 2.8 years (range 3 months-6.2 years) of follow-up. Three patients with local encephalocele disconnection were almost seizure-free or exhibited worthwhile improvement. Histologically, all 12 surgical patients had gliosis at the base of the encephalocele; some had cortical laminar disorganization (n = 5) or mild hippocampal degeneration (n = 1). CONCLUSIONS: The possibility of a temporal encephalocele should be considered when interpreting MRI examinations of patients with medically intractable focal epilepsy. These patients can significantly benefit from unitemporal epilepsy surgery, even in cases with bilateral encephaloceles.
OBJECTIVE: To report the increasing frequency with which temporal anteroinferior encephalocele is a cause of adult temporal lobe epilepsy, to illustrate the clinical and imaging characteristics of this condition, and to report its surgical treatment in a series of 23 adult patients. METHODS:Epilepsypatients diagnosed with temporal anteroinferior encephalocele from January 2006 to December 2013 in a national epilepsy reference center were included in this noninterventional study. RESULTS: Twenty-three epilepsypatients (14 female, mean age 43.8 years) were diagnosed with temporal anteroinferior encephalocele in our institute. Thirteen patients had ≥2 encephaloceles; 7 cases presented bilaterally. The estimated frequency of this condition was 0.3% among MRI examinations performed due to newly diagnosed epilepsy (n = 6) and 1.9% among drug-resistant patients referred to our center (n = 17). Nine patients with local encephalocele disconnection (n = 4) or anterior temporal lobectomy and amygdalohippocampectomy (n = 5) have become seizure-free (Engel 1) for a mean 2.8 years (range 3 months-6.2 years) of follow-up. Three patients with local encephalocele disconnection were almost seizure-free or exhibited worthwhile improvement. Histologically, all 12 surgical patients had gliosis at the base of the encephalocele; some had cortical laminar disorganization (n = 5) or mild hippocampal degeneration (n = 1). CONCLUSIONS: The possibility of a temporal encephalocele should be considered when interpreting MRI examinations of patients with medically intractable focal epilepsy. These patients can significantly benefit from unitemporal epilepsy surgery, even in cases with bilateral encephaloceles.
Authors: João Paulo Sant Ana Santos de Souza; Jeff Mullin; Connor Wathen; Juan Bulacio; Patrick Chauvel; Lara Jehi; Jorge Gonzalez-Martinez Journal: Neurosurg Rev Date: 2017-10-16 Impact factor: 3.042
Authors: Firas Bannout; Sheri Harder; Michael Lee; Alexander Zouros; Ravi Raghavan; Travis Fogel; Kenneth De Los Reyes; Travis Losey Journal: Brain Sci Date: 2018-03-12