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Temporal lobe epilepsy due to meningoencephaloceles into the greater sphenoid wing: a consequence of idiopathic intracranial hypertension?

  • Diagnostic Neuroradiology
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Abstract

Purpose

Antero-inferior temporal lobe meningoencephaloceles are a rare, but increasingly recognized cause of drug-resistant temporal lobe epilepsy (TLE). In order to evaluate whether these lesions are related to idiopathic intracranial hypertension (IIH), we analyzed clinical and MRI findings of a cohort of patients undergoing presurgical work-up.

Methods

Seizure onset in the anterior temporal lobe was proven by EEG electrodes in 22 patients, and in 21 patients, anterior temporal lobectomy (mostly with sparing of the hippocampus) was performed. MRI signs of IIH (in particular empty sella) and the volumes of the ventricles and external CSF spaces were determined and related to the body mass index (BMI) and clinical outcome.

Results

Six of seven obese (BMI > 30 kg/m2) compared to four of 15 non-obese patients had partial empty or empty sella (p = 0.007). Bilateral lesions were found in all obese and 11 patients. Seizure freedom (Engel class 1A) was achieved in 12 of 21 patients (5 obese compared to 7 non-obese patients). BMI was related to the volume of the external CSF spaces (r = 0.467), and age at seizure onset was higher in obese patients.

Conclusion

Roughly a third of patients with temporal lobe epilepsy due to antero-inferior meningoencephaloceles is obese and has MRI signs of idiopathic intracranial hypertension.

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Abbreviations

BMI:

Body mass index

TLE:

Temporal lobe epilepsy

IIH:

Idiopathic intracranial hypertension

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Author information

Authors and Affiliations

  1. Dept. of Neuroradiology, Medical Center – University of Freiburg, Faculty of Medicine, University of Freiburg, Breisacher Str. 64, 79106, Freiburg, Germany

    H. Urbach, G. Jamneala, I. Mader, K. Egger & S. Yang

  2. Dept. of Epileptology, Medical Center – University of Freiburg, Faculty of Medicine, University of Freiburg, Freiburg, Germany

    D. Altenmüller

Authors
  1. H. Urbach
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  2. G. Jamneala
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  3. I. Mader
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  4. K. Egger
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  5. S. Yang
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  6. D. Altenmüller
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Correspondence to H. Urbach.

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The authors declare that they have no conflict of interest.

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All procedures performed in the studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki Declaration and its later amendments or comparable ethical standards. For this type of study formal consent is not required.

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Urbach, H., Jamneala, G., Mader, I. et al. Temporal lobe epilepsy due to meningoencephaloceles into the greater sphenoid wing: a consequence of idiopathic intracranial hypertension?. Neuroradiology 60, 51–60 (2018). https://doi.org/10.1007/s00234-017-1929-5

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  • DOI: https://doi.org/10.1007/s00234-017-1929-5

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