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Updated: Jun 14, 2026
Electromagnetic Source Imaging in Presurgical Evaluation of Children with Drug-Resistant Epilepsy
Published on: September 20, 2024
Microencephaloceles: another dual pathology of intractable temporal lobe epilepsy in childhood
Kristian Aquilina1, Dave F Clarke, James W Wheless
1Department of Neurosurgery, Frenchay Hospital, Bristol, United Kingdom.
Abstract:
Temporal lobe encephaloceles can be associated with temporal lobe epilepsy. The authors report on the case of an adolescent with multiple microencephaloceles, in the anterolateral middle fossa floor, identified at surgery (temporal lobectomy) for intractable partial-onset seizures of temporal origin. Magnetic resonance imaging revealed only hippocampal atrophy. Subdural electrodes demonstrated ictal activity arising primarily from the anterior and lateral temporal lobe, close to the microencephaloceles, spreading to the anterior and posterior mesial structures. Pathological examination revealed diffuse temporal gliosis involving the hippocampus, together with microdysgenesis of the amygdala. The literature on epilepsy secondary to encephaloceles is reviewed and the contribution of the microencephaloceles to the seizure disorder in this patient is discussed.
Insights
Multiple microencephaloceles in the temporal lobe were linked to intractable epilepsy in an adolescent. Surgical findings revealed these microencephaloceles correlated with seizure origins, suggesting a role in the epilepsy disorder.
Area of Science:
- Neurology
- Neurosurgery
- Epileptology
Background:
- Temporal lobe encephaloceles are recognized associations with temporal lobe epilepsy.
- Intractable partial-onset seizures often necessitate surgical intervention for diagnosis and treatment.
Observation:
- An adolescent patient presented with intractable partial-onset seizures originating from the temporal lobe.
- Surgical exploration revealed multiple microencephaloceles in the anterolateral middle fossa floor.
- Preoperative magnetic resonance imaging (MRI) primarily showed hippocampal atrophy.
Findings:
- Subdural electrode monitoring localized ictal activity to the anterior and lateral temporal lobe, adjacent to the microencephaloceles.
- Pathological examination identified diffuse temporal gliosis, hippocampal involvement, and amygdala microdysgenesis.
- The study discusses the potential contribution of these microencephaloceles to the patient's seizure disorder.
Implications:
- This case highlights the importance of considering microencephaloceles in the etiology of intractable temporal lobe epilepsy.
- Findings suggest that even subtle encephalocele-related structural abnormalities can significantly contribute to epileptogenesis.
- Further research into the relationship between encephaloceles and epilepsy may refine diagnostic and therapeutic strategies.
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