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

Fumin Tong; Valerie Jewells; Dimitri G Trembath; Eldad Hadar; Hae Won Shin

doi:10.1016/j.ebcr.2015.06.010

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

Epilepsy Behav Case Rep. 2015 Aug 8:4:52-5. doi: 10.1016/j.ebcr.2015.06.010. eCollection 2015.

Authors

Fumin Tong¹, Valerie Jewells², Dimitri G Trembath³, Eldad Hadar⁴, Hae Won Shin¹

Affiliations

¹ Department of Neurology, University of North Carolina, Chapel Hill, NC 27599, USA.
² Department of Radiology, University of North Carolina, Chapel Hill, NC 27599, USA.
³ Department of Pathology and Laboratory Medicine, University of North Carolina, Chapel Hill, NC 27599, USA.
⁴ Department of Neurosurgery, University of North Carolina, Chapel Hill, NC 27599, USA.

Abstract

Mesial temporal sclerosis (MTS) is a well-recognized cause of intractable epilepsy; however, coexistence with focal cortical dysplasia (FCD) is less common. Middle fossa epidermoid cysts are rare and may involve the temporal lobe. Most epidermoids are clinically silent, slow-growing, and seldom associated with overt symptomatology, including seizures. We describe a patient with multiple comorbidities including left MTS and a large epidermoid cyst involving the left quadrigeminal plate cistern compressing upon the cerebellar vermis and tail of the left hippocampus, resulting in refractory left temporal lobe epilepsy. The patient underwent left anterior temporal lobectomy. The surgical pathology demonstrated a third pathological finding of left temporal FCD type Ia. The patient has been seizure-free since the surgery. This case provides additional information with regard to the understanding of epileptogenicity and surgical planning in patients with MTS and epidermoid cysts.

Keywords: Epidermoid cysts; Epilepsy surgery; Focal cortical dysplasia; Mesial temporal sclerosis; Refractory temporal epilepsy.