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Brain Sci. 2018, 8(3), 42; https://doi.org/10.3390/brainsci8030042

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

1
Department of Neurology, Loma Linda University Health, Loma Linda, CA 92354, USA
2
Department of Radiology (Division of Neuroradiology); Loma Linda University Health, Loma Linda, CA 92354, USA
3
Department of Radiology, Los Angeles County and University of Southern California Medical Center, Los Angeles, CA 90033, USA
4
Department of Neurosurgery, Loma Linda University Health, Loma Linda, CA 92354, USA
5
Department of Pathology, Human Anatomy & Neurosurgery, Loma Linda University Health, Loma Linda, CA 92354, USA
6
Loma Linda Physical Medicine and Rehabilitation, Neuropsychology; Loma Linda University Health, Loma Linda, CA 92354, USA
*
Author to whom correspondence should be addressed.
Received: 31 January 2018 / Revised: 7 March 2018 / Accepted: 8 March 2018 / Published: 12 March 2018
(This article belongs to the Special Issue Diagnosis and Surgical Treatment of Epilepsy)
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Abstract

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. View Full-Text
Keywords: temporal lobe epilepsy; encephalocele; meningoencephalocele; tailored surgery temporal lobe epilepsy; encephalocele; meningoencephalocele; tailored surgery
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Bannout, F.; Harder, S.; Lee, M.; Zouros, A.; Raghavan, R.; Fogel, T.; De Los Reyes, K.; Losey, T. Epilepsy Surgery for Skull-Base Temporal Lobe Encephaloceles: Should We Spare the Hippocampus from Resection? Brain Sci. 2018, 8, 42.

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