• Seijiro Shimada, Naoto Kunii, Kensuke Kawai, Kenichi Usami, Takeshi Matsuo, Takeshi Uno, Tomoyuki Koizumi, and Nobuhito Saito.
• Department of Neurosurgery, the University of Tokyo Hospital, Tokyo, Japan.
• World Neurosurg. 2015 Sep 1; 84 (3): 867.e1-6.

BackgroundRefractory temporal lobe epilepsy due to spontaneous temporal pole encephalocele is a rare but increasingly recognized condition. Optimal surgical management is complicated by the lack of knowledge regarding both the extent of the epileptogenic area and the need for repair of the encephalocele.Case DescriptionWe report two cases that add significant information to these issues. In Case 1, with a 5-year history of refractory seizures, implantation of diagnostic subdural electrodes into the anterior temporal base happened to abolish the seizures completely. No structural changes were evident on postoperative magnetic resonance imaging. In Case 2, with a large encephalocele and a 5-year history of refractory seizures, surgical disconnection of the temporal pole successfully abolished seizures without any need for encephalocele repair.ConclusionsThese two cases support the view that the epileptogenic area is confined to within the temporal pole for spontaneous temporal pole encephalocele. Temporopolar disconnection represents one surgical option for this entity that achieves seizure cessation without requiring extra repair procedures.Copyright © 2015 Elsevier Inc. All rights reserved.

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