Encephaloceles and Epilepsy: A Review of Diagnosis, Management, and Outcomes
Abstract number :
V.083
Submission category :
9. Surgery / 9A. Adult
Year :
2021
Submission ID :
1825834
Source :
www.aesnet.org
Presentation date :
12/9/2021 12:00:00 PM
Published date :
Nov 22, 2021, 06:50 AM
Authors :
Andres Ramos-Fresnedo, MD - Mayo Clinic Florida; Ricardo Domingo, MD - Mayo Clinic Florida; Ryan McGeary, DO - Mayo Clinic Florida; Joseph Sirven, MD - Mayo Clinic Florida; Anteneh Feyissa, MD - Mayo Clinic Florida; William Tatum, DO - Mayo Clinic Florida; Anthony Ritaccio, MD - Mayo Clinic Florida; Erik Middlebrooks, MD - Mayo Clinic Florida; Sanjeet Grewal, MD - Mayo Clinic Florida
Rationale: Encephaloceles are known to be a lesional cause of focal epilepsy.1 Although the most common location is the temporal lobe (Figure 1), cases of extratemporal encephaloceles have been reported.2 Data on the association between encephaloceles and epilepsy are scarce and current literature is limited in regard to their diagnosis, management, and outcomes as the literature is mostly comprised of case reports, case series, and retrospective studies (Table 1).
Methods: We conducted a broad literature review through MEDLINE for manuscripts related to encephaloceles and epilepsy regardless of level of evidence using the following keywords: epilepsy, encephalocele, meningoencephalocele, convulsion, seizure. Single patient data were extracted from each included manuscript for use in descriptive analysis.
Results: A total of 117 articles were found on an initial search for encephalocele, seizures and epilepsy in adults. 36 scientific reports that fulfilled our inclusion criteria were included and yielded 267 unique patients. The majority of reported patients had recurrent focal impaired awareness seizures (21.72%), followed by a combination of focal to bilateral tonic-clonic seizures (16.10%). Although most of the encephaloceles were located in the temporal lobe (98.13%), we found five cases of extra-temporal encephaloceles associated with focal epilepsy (1.87%). From the total cohort, 79.78% of patients underwent an epilepsy surgical procedure. Partial lobectomy was the most common surgical procedure (25.47%, n=68), followed by lesionectomy alone (17.22%, n=46). From the patients who underwent any surgical intervention (n=126), 77 were seizure-free without anti-seizure medications (61.11%, follow-up 6-84 months), 7 were seizure-free with anti-seizure medications (5.56%, follow-up 12-48 months), and 7 continued to have seizures (5.56%). Patients who underwent lesionectomy alone attained seizure freedom in 86.95% (follow-up range 3-48 months, and 44.12% of patients who underwent lobectomy were seizure-free at the time of last follow-up (follow-up range 7-74 months).
Conclusions: There is no consensus on the appropriate surgical management for people with epilepsy and encephaloceles on neuroimaging. Nearly all encephaloceles reported were located in the temporal lobe. Published data supports surgical management including lesionectomy or lobectomy when seizures are drug resistant. Current data suggests initial lesionectomy and defect repair should be considered when the network is felt to be well-localized to the encephalocele.
Funding: Please list any funding that was received in support of this abstract.: No funding received in support of this abstract.
Surgery