Triple pathological findings in a surgically amenable patient with mesial temporal lobe epilepsy

Area of Science:

• Neurology
• Neurosurgery
• Pathology

Background:

• Mesial temporal sclerosis (MTS) is a common cause of intractable epilepsy.
• Focal cortical dysplasia (FCD) can also cause epilepsy, but its coexistence with MTS is infrequent.
• Middle fossa epidermoid cysts are rare, slow-growing tumors that rarely cause seizures.

Purpose of the Study:

• To describe a unique case of refractory left temporal lobe epilepsy.
• To investigate the interplay between MTS, an epidermoid cyst, and FCD in epileptogenesis.
• To evaluate the surgical outcomes for such a complex case.

Main Methods:

• Case report of a patient with MTS, an epidermoid cyst, and FCD.
• Detailed neuroimaging and surgical description.
• Analysis of surgical pathology findings.

Main Results:

• The patient presented with refractory left temporal lobe epilepsy due to coexisting MTS and a large epidermoid cyst.
• Surgical pathology revealed a third finding: left temporal FCD type Ia.
• The patient achieved complete seizure freedom after left anterior temporal lobectomy.

Conclusions:

• This case underscores the possibility of multiple pathologies contributing to refractory epilepsy.
• It offers insights into the complex epileptogenicity in patients with MTS and epidermoid cysts.
• Successful surgical management highlights the importance of thorough pathological evaluation and tailored surgical planning.