Clinical analysis of refractory epilepsy caused by temporal encephalocele

doi:10.3969/j.issn.1006-7795.2026.03.024

Abstract

Abstract: Objective This study aims to clarify the diagnostic clues and treatment strategies for temporal lobe encephalocele by analyzing the clinical data of patients with temporal lobe encephalocele.Methods We retrospectively analyzed patients with temporal lobe epilepsy treated at Beijing Tiantan Hospital, Capital Medical University between January 2020 and August 2025. Among 158 patients who underwent temporal lobe epilepsy surgery, 7 patients with temporal encephalocele were enrolled as the study cohort. Their clinical characteristics, electroencephalography (EEG), neuroimaging, neuropsychological assessments, and longterm prognosis were analyzed. Results The 7 patients included 4 males and 3 females, with a mean age of 42.4 years (range 28-72 years). All 7 patients presented with focal impaired awareness seizures, and 5 had focal to bilateral tonicclonic seizures. Initial magnetic resonance imaging (MRI) detected temporal encephalocele in only 2 patients; the other 5 were missed. Of the 7 patients, 6 underwent standard anterior temporal lobectomy with meningeal repair, and 1 received medical treatment only. After a mean followup of 28 months (range 14-55 months), 5 patients achieved Engel class I, 1 achieved Engel class Ⅱa, and 1 had Engel class Ⅳ. Pathological findings showed gliosis in 5 patients and gangliocytoma in 1 patient. Cognitive evaluation revealed that memory impairment was more common in patients with leftsided lesions. Conclusion In patients with drugresistant temporal lobe epilepsy, MRI and other neuroimages should be carefully reviewed to rule out temporal encephalocele. Surgical intervention in patients with temporal lobe epilepsy related to encephalocele can improve longterm clinical prognosis.

Key words: temporal encephalocele, temporal lobe epilepsy, drug resistant epilepsy, magnetic resonance imaging, epilepsy surgery, prognosis

CLC Number:

R742.1

Gao Wulin, Fan Hongfei, Chen Weida, Cui Tao, Wang Hua. Clinical analysis of refractory epilepsy caused by temporal encephalocele[J]. Journal of Capital Medical University, 2026, 47(3): 603-611.

References

［1］Van Gompel J J, Miller J W. How epileptogenic are temporal encephaloceles?［J］. Neurology, 2015, 85(17): 1440-1441.
［2］Pillai R, Chheda A, Agrawal S, et al. Skull-base temporal encephalocele: hidden cause of temporal lobe epilepsy［J］. J Postgrad Med, 2024, 70(2): 97-100.
［3］Morone P J, Sweeney A D, Carlson M L, et al. Temporal lobe encephaloceles: a potentially curable cause of seizures［J］. Otol Neurotol, 2015, 36(8): 1439-1442.
［4］Ortiz A V, Eisma J J, Martin D, et al. Detection challenges of temporal encephaloceles in epilepsy: a retrospective analysis［J］. Magn Reson Imaging, 2025, 115: 110272.
［5］Kamiya K, Mori H, Kunimatsu A, et al. Two cases of spontaneous temporal encephalocele［J］. J Neuroradiol, 2012, 39(5): 360-363.
［6］Zillgitt A J, Mong E R, Manasseh A M, et al. Exploration of epileptic networks in temporal lobe encephaloceles with stereotactic EEG: electroclinical characteristics and surgical outcomes［J］. Epilepsia Open, 2024, 9(6): 2395-2407.
［7］Leblanc R, Tampieri D, Robitaille Y, et al. Developmental anterobasal temporal encephalocele and temporal lobe epilepsy［J］. J Neurosurg, 1991, 74(6): 933-939.
［8］伍犹梁, 张晓静, 余佳彬, 等. 蝶骨翼脑膜脑膨出合并难治性颞叶癫痫2例手术治疗并文献复习［J］. 立体定向和功能性神经外科杂志, 2021, 34(2): 105-107.
［9］李俊萍, 陈庆, 陈意欣. 1例癫痫并脑膜脑膨出患儿的围手术期护理［J］. 中国实用护理杂志, 2013, 29(1): 56-57.
［10］Bernasconi A, Cendes F, Theodore W H, et al. Recommendations for the use of structural magnetic resonance imaging in the care of patients with epilepsy: a consensus report from the International League Against Epilepsy Neuroimaging Task Force［J］. Epilepsia, 2019, 60(6): 1054-1068.
［11］Beniczky S, Trinka E, Wirrell E, et al. Updated classification of epileptic seizures: position paper of the international league against epilepsy［J］. Epilepsia, 2025, 66(6): 1804-1823.
［12］Saavalainen T, Jutila L, Mervaala E, et al. Temporal anteroinferior encephalocele: an underrecognized etiology of temporal lobe epilepsy?［J］. Neurology, 2015, 85(17): 1467-1474.
［13］Landreneau F E, Mickey B, Coimbra C. Surgical treatment of cerebrospinal fluid fistulae involving lateral extension of the sphenoid sinus［J］. Neurosurgery, 1998, 42(5): 1101-1104; discussion 1104-1105.
［14］Zuluaga M, Valencia-Cifuentes V, Recio M A, et al. Encephalocele-associated temporal lobe refractory epilepsy: report of two cases［J］. Epilepsy Behav Rep, 2025, 29: 100752.
［15］Jagtap S A, Kurwale N, Patil S, et al. Temporal encephalocele: a rare but treatable cause of temporal lobe epilepsy［J］. Epileptic Disord, 2022, 24(6): 1073-1080.
［16］Berry A D 3rd, Patterson J W. Meningoceles, meningomyeloceles, and encephaloceles: a neuro-dermatopathologic study of 132 cases［J］. J Cutan Pathol, 1991, 18(3): 164-177.
［17］Lapalme-Remis S, Witte R J, Wong-Kisiel L C. Anteroinferior temporal encephalocele: a surgically treatable cause of pharmacoresistant epilepsy［J］. Pediatr Neurol, 2017, 77: 89-90.
［18］Tse G T, Frydman A S, O'Shea M F, et al. Anterior temporal encephaloceles: elusive, important, and rewarding to treat［J］. Epilepsia, 2020, 61(12): 2675-2684.
［19］Panov F, Li Y, Chang E F, et al. Epilepsy with temporal encephalocele: characteristics of electrocorticography and surgical outcome［J］. Epilepsia, 2016, 57(2): e33-e38.
［20］Campbell Z M, Hyer J M, Lauzon S, et al. Detection and characteristics of temporal encephaloceles in patients with refractory epilepsy［J］. AJNR Am J Neuroradiol, 2018, 39(8): 1468-1472.
［21］Buraniqi E, Guerin J B, Miller K J, et al. Temporal encephalocele: a treatable etiology of drug-resistant pediatric temporal lobe epilepsy［J］. Pediatr Neurol, 2023, 142: 32-38.
［22］Khoudari H, Alabbas M, Tobocnik S, et al. Seizure outcomes after resection of temporal encephalocele in patients with drug-resistant epilepsy: a systematic review and meta-analysis［J］. Epilepsia, 2025, 66(4): 945-954.
［23］Cox B C, Agashe S H, Smith K M, et al. EEG source localization in temporal encephaloceles: concordance with surgical resection and clinical outcomes［J］. J Clin Neurophysiol, 2023, 41(6): 515-521.
［24］Smith K M, Kanth K M, Krecke K N, et al. Drug-resistant temporal lobe epilepsy with temporal encephaloceles: how far to resect［J］. Epilepsy Behav, 2023, 148: 109472.［25］Zhou D J, Woodson-Smith S, Emmert B E, et al. Clinical characteristics and surgical outcomes of epilepsy associated with temporal encephalocele: a systematic review［J］. Epilepsy Behav, 2024, 158: 109928.
［26］De Souza J P S A S, Mullin J, Wathen C, et al. The usefulness of stereo-electroencephalography (SEEG) in the surgical management of focal epilepsy associated with “hidden” temporal pole encephalocele: a case report and literature review［J］. Neurosurg Rev, 2018, 41(1): 347-354.

[1]	Zhao Youquan, Xiong Tianyu, Xie Ping, Niu Yinong. Prediction of adverse pathological features after radical prostatectomy for prostate cancer by clinical indicators and association with biochemical failure [J]. Journal of Capital Medical University, 2026, 47(2): 259-266.
[2]	Xiong Tianyu, Zhao Youquan, Xie Ping, Niu Yinong. Prediction model for biochemical recurrence after radical prostatectomy based on pathological features [J]. Journal of Capital Medical University, 2026, 47(2): 267-274.
[3]	Yao Linyin, Sun Zhifu, Guo Yichen, Wang Jianhong, Gu Qinglong, Yi Xiaoli. Characteristics and influencing factors of neuropsychiatric symptoms in patients with persistent olfactory loss [J]. Journal of Capital Medical University, 2026, 47(2): 375-381.
[4]	Stroke Prevention Project, National Health Commission, Stroke Prevention and Control Professional Committee of the Chinese Preventive Medicine Association. Chinese expert consensus on cytoprotection based on reperfusion therapy for acute ischemic stroke [J]. Journal of Capital Medical University, 2026, 47(1): 1-9.
[5]	Ma Yeping, Liu Xiaojing, Wang Xiaoqi, Li Zhongxin. Association of serum potassium variability and long-term prognosis in maintenance hemodialysis patients [J]. Journal of Capital Medical University, 2026, 47(1): 157-162.
[6]	Chen Lu, Jiang Xue, Guo Xinying, Liu Jian, Guo Caixia. Risk factors and prognostic implications of acute myocardial infarction complicated with pericardial effusion [J]. Journal of Capital Medical University, 2025, 46(6): 1033-1043.
[7]	Li Xin, Jiang Wenjian, Han Jie, Zhang Hongjia. Clinical outcomes of mitral valve repair in patients with rheumatic mitral valve disease and risk factors for long-term prognosis [J]. Journal of Capital Medical University, 2025, 46(5): 885-891.
[8]	Mao Wenping, Han Qian, Jiao Fengwei, Wang Jing, Huang Kewu. The predictive value of serum β2M level for prognosis in exacerbated COPD and the results of when it is compared with other inflammatory markers [J]. Journal of Capital Medical University, 2025, 46(4): 718-723.
[9]	Liu Xiaoqian, Sun Kai, Wang Xiaolin, Zhao Qianqian, Wu Xiaoxiao, Shen Fangqi, Chen Xi, Tian Chenxu, Wu Di, Song Chunhua, Xu HongXia, Cong Minghua, Shi Hanping, Jia Pingping. Comparison of the prognostic value of 15 nutritional/inflammatory indicators in postoperative cancer patients [J]. Journal of Capital Medical University, 2025, 46(3): 410-419.
[10]	Yang Peiyi, Duan Chao, Wang Shengcai, Jin Mei, Zhang Dawei, Fu Libing, Yu Tong, Liu Zhikai, Ma Xiaoli, Ni Xin, Su Yan. Analysis of clinical features and prognosis in pediatric malignant solid tumors of head and neck in single-center [J]. Journal of Capital Medical University, 2025, 46(3): 545-552.
[11]	Fan Yunpeng, Xiong Tianyu, Yang Kun, Liu Zhanliang, Jin Song, Xie Ping, Niu Yinong. Prediction model for extraprostatic extension of prostate based on MRI and clinical indicators [J]. Journal of Capital Medical University, 2025, 46(2): 243-251.
[12]	Ya• Naren, Liu Yan, Zhou Xia, Zhu Dekun, Chen Feng, Ma Zhengfei, Li Chuanhui, Sun Zhongwu. Cerebral angiographic features and prognostic study in patients with central retinal artery occlusion [J]. Journal of Capital Medical University, 2025, 46(1): 15-21.
[13]	Zhang Meng, Ma Yongxin, Jia Qiong , Zhang Dongwei, Zhang Xinhong, Xu Yaoming . Clinical observation on the efficacy and safety of intravenous thrombolysis in the treatment of acute mild non-disabling ischemic stroke: a single-center retrospective observational study [J]. Journal of Capital Medical University, 2025, 46(1): 56-62.
[14]	Qin Yunlong, Zhou Jin, Liu Meng, Luo Kaifa, Wang Anjing, Wang Di, Zhao Jin, Sun Shiren. Analysis of clinicopathological characteristics and prognosis of malignant hypertensive nephrosclerosis [J]. Journal of Capital Medical University, 2024, 45(5): 838-845.
[15]	Xu Yuan, Liang Naixin, Liu Hongsheng. Prognostic factors in neoadjuvant immunotherapy for non-small cell lung cancer：pathologic lymph node metastasis and primary tumor response [J]. Journal of Capital Medical University, 2024, 45(4): 649-653.