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Occult encephaloceles and temporal lobe epilepsy

Developmental and acquired lesions in the middle fossa

From the Department of Neurology and Neurosurgery, McGill University, and the Montreal Neurological Hospital and Institute, Montreal, Quebec, Canada.

Three patients with medically refractory partial complex seizures were shown to have small and initially unsuspected encephaloceles of the middle fossa. All had bitemporal, independent, interictal epileptogenic abnormalities, and the side of origin of the seizures could not be determined by surface EEG alone. The encephaloceles were missed on the initial radiologic studies and were found retrospectively in two patients; the third was found at operation and was not demonstrable radiologically, even in retrospect. One was the sequel of remote mastoid surgery, another was neoplasm-related, and the third, developmental. In all, bony defects of the middle cranial fossa were associated with temporal lobe herniation. The patients were treated surgically and have had no further partial complex seizures since operation.

Address correspondence and reprint requests to Dr. Frederick Andermann, Montreal Neurological Hospital and Institute, 3801 University Street, Montreal, Quebec H3A 2B4.

Presented in part at the Fourteenth International Epilepsy Symposium, August, 1982, London, England.

Accepted for publication June 14, 1983.

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