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• Temporal lobe encephalocele is a rarely recognized cause of medically refractory epilepsy. • Temporal encephaloceles may have variable semiology, sharing features with mesial temporal lobe epilepsies. • Temporal lobe encephaloceles typically present with high-amplitude delta or medium-amplitude theta patterns on EEG. • Early detection of encephaloceles in intractable temporal lobe epilepsy can enable tailored resections with favorable outcomes. Our study aimed to investigate the management of patients with medically refractory epilepsy related to temporal encephaloceles, focusing on the use of ancillary testing in the pre-surgical evaluation to optimize surgical outcomes. We conducted a retrospective analysis of electronic medical records from the Cleveland Clinic, covering the period from January 2000 to May 2020. Patients with drug-resistant temporal lobe epilepsy were included if they had temporal lobe encephaloceles and required surgical intervention. We reviewed the results of ancillary studies, including invasive EEG. A total of 19 patients with temporal lobe encephaloceles underwent resection for drug-resistant epilepsy treatment. Among them, 63 % reported experiencing auras commonly associated with mesial temporal lobe epilepsy, such as autonomic, psychic, and abdominal symptoms, followed by dialeptic seizures. Ictal patterns were consistently ipsilateral, with high amplitude delta or medium amplitude theta activity at onset, predominantly localized to the frontotemporal region in more than half of the cases. In 35 % of these patients, encephaloceles were only diagnosed during surgery. Stereo-EEG evaluation revealed two distinct ictal patterns: one characterized by localized low voltage fast activity in the temporal pole evolving into a 3–4 Hz high amplitude diffuse spiky activity, and the other exhibiting low amplitude rhythmic theta activity in the temporal pole with late involvement of the amygdala/hippocampus. Surgical resection strategy was based on clinical history and ancillary data analysis. At one-year follow-up after resection, 63 % of the patients attained Engel I seizure control over an average duration of 44 months (ranging from 6 months to 7.3 years). Additionally, 18 % of the patients achieved an Engel II outcome. Tailored resection of the encephalocele and the surrounding temporal pole, while preserving the mesial temporal structures, can effectively control seizures in patients with temporal encephaloceles identified through MRI. Patients presenting with temporal lobe symptoms and scalp ictal patterns characterized by polymorphic high delta theta activity with frontotemporal evolution should be evaluated for temporal encephaloceles as a potential underlying cause of their seizures, especially when the MRI is otherwise unrevealing. [ABSTRACT FROM AUTHOR]

Objective: In patients with temporal lobe epilepsy (TLE) with a nonlesional and nonepileptogenic hippocampus (HC), in order to preserve functionally intact brain tissue, the HC is not resected. However, some patients experience postoperative memory decline, possibly due to disruption of the extrahippocampal memory network and secondary hippocampal volume (HV) loss. The purpose of this study was to determine the extent of hippocampal atrophy ipsilateral and contralateral to the side of the surgery and its relation to memory outcomes. Methods: Hippocampal volume and verbal as well as visual memory performance were retrospectively examined in 55 patients (mean age ± standard deviation [SD] 30 ± 15 years, 25 female, 31 left) before and 5 months after surgery within the temporal lobe that spared the entire HC. HV was extracted based on prespecified templates, and resection volumes were also determined. Results: HV loss was found both ipsilateral and contralateral to the side of surgery (P <.001). Postoperative left HV loss was a significant predictor of postoperative verbal memory deterioration after left‐sided surgery (P <.01). Together with the preoperative verbal memory performance, postoperative left HV explained almost 60% of the variance (P <.0001). However, right HV was not a clear predictor of visual memory performance. Larger resection volumes were associated with smaller postoperative HV, irrespective of side of surgery (left: P <.05, right: P <.01). Significance: A disruption of the memory network by any resection within the TL, especially within the language‐dominant hemisphere, may lead to HC atrophy and memory decline. These findings may further improve the counseling of patients concerning their postoperative memory outcome before TL resections sparing the entire HC. [ABSTRACT FROM AUTHOR]

The article presents a study which analyzes the long-term surgical outcomes of tumor-related temporal lobe epilepsy (TLE) and assesses its corresponding surgical practice. The clinical data assessment of 87 TLE-diagnosed patients and its surgical outcome evaluation based on seizure control, tumor control and discontinuation of antiepileptic drugs (AEDs) via electroencephalogram (EEG) was used. It recommends maximal tumor removal as it manifests 79% postoperative occurrence of acturial seizure.

Summary: Purpose: We investigated whether intraoperative magnetic resonance imaging (MRI) was able to assess immediately the extent of a tailored temporal lobe resection for epilepsy in comparison to delayed postoperative MRI. The recently proposed concept of an individually tailored procedure, preserving tissue not involved in seizures, leads to a variety of differently shaped resections. Methods: For intraoperative imaging we used a Magnetom Open 0.2 Tesla scanner. Fifty-eight patients undergoing temporal lobe resections for pharmacoresistant epilepsy were investigated. Half of these were nonlesional. All patients had delayed postoperative follow-up scans, which were compared with the intraoperative, postresection images. Results: In 49 (84%) of 58 cases, intraoperative MRI depicted the resection cavity identical to delayed postoperative studies. Complete resection of the visible lesion was primarily proved in 23 of the 29 cases. In two patients with lesions and in one nonlesional case, the resection was extended after intraoperative imaging, thus increasing the rate of total resections in gliomas from 73 to 87%. In four patients, an extension into eloquent areas did not allow complete removal. In the nonlesional cases (n = 29), the extent of tailored temporal resections also could be exactly documented intraoperatively. Conclusions: Intraoperative MRI allowed a reliable evaluation of the localization and extent of resection in epilepsy surgery within the operative procedure. Furthermore, it provided the possibility of an image-based correction of an initially incomplete resection, particularly in lesional cases. In the majority of patients, the intraoperative images would have been able to replace delayed postoperative MRI. However, in 16%, there were postoperative changes in the resection volume. [ABSTRACT FROM AUTHOR]