Temporal Lobe Encephaloceles: A Potentially Curable Cause of Seizures

Background: Temporal lobe encephaloceles are characterized by herniation of the meninges and brain parenchyma through a bony defect in the floor of the middle fossa. Disease presentation is variable and includes conductive hearing loss, cerebrospinal fluid (CSF) leak, meningitis, and seizures, with the latter being particularly uncommon. Herein, we report our experience managing the rare subgroup of patients with temporal encephaloceles associated with epileptiform activity.

Materials and Methods: A retrospective chart review of three patients with generalized tonic–clonic seizures and CSF rhinorrhea. Medical work-up ultimately revealed evidence of a temporal lobe encephalocele in the floor of the middle fossa confirmed with magnetic resonance imaging (MRI) and computed tomography (CT).

Results: All the patients underwent resection of the temporal lobe encephalocele with subsequent repair of the middle fossa floor defect. Following surgery, CSF rhinorrhea resolved, and all patients remained seizure-free through their last available follow-up.

Conclusion: Temporal lobe encephaloceles are an infrequent cause of seizures. Given that these lesions can be missed with standard imaging modalities, they are likely under diagnosed on initial medical evaluation. This diagnosis should be considered in patients with intractable seizures. If an encephalocele is found, resection of the herniation and repair of the temporal floor defect can be definitive treatment.