Exploring Dural Sinus Stenosis Rates in Temporal Lobe Epilepsy With and Without Temporal Lobe Encephaloceles
Sivani Lingam1, Akshaya Prabhakaran3, William Liu2, Vishal Shah2, Jennifer Cheng4, Kelly Dahlstrom2, Michael Abraham5, Patrick Landazuri6
1Neurology, University of Kansas Medical Center, 2University of Kansas Medical Center, 3Neurology, University of Texas Southwestern, 4KU Medical Center, 5The University of Kansas Health System, 6University of Kansas - Department of Neurology - Comprehensive Epilepsy Center
Background:
Temporal lobe encephaloceles (TL-EC), a recognized cause of TLE, are associated with idiopathic intracranial hypertension (IIH). One hypothesis for TL-EC formation is pulsatile CSF forces secondary to raised ICP, leading to CSF pockets and formation of encephaloceles. The pathophysiology of IIH is related to DSS. We compared DSS rates in TLE patients with and without TL-EC, as this could have new surgical implications for TLE patients with TL-EC.
Design/Methods:
In this retrospective cohort study, we utilized the University of Kansas Medical Center epilepsy surgery registry to identify TLE patients (verified by Engel 1 outcome) with TL-EC (25) and matched them with a non-TL-EC (23) cohort by BMI. Four physicians of different training and specialties (neuroradiologist = gold standard, neuro-interventionalist, epileptologist, resident neurologist) reviewed blinded MRI brain images (contrasted T1 axial 1mm sections) to asses for TL-EC. The relative risk of DSS was calculated and chi-sqaured tests assessed the accuracy of identifying encephaloceles.
Results:
DSS rates were 88% in TL-EC patients (22/25) compared to 26% in non-TL-EC patients (6/23), with a relative risk of 3.37 (95% CI [1.7, 6.8], p=0.0007). Encephaloceles were correctly identified 80% of the time (20/25) by the epileptologist, 68% (17/25) by the neuro-interventionalist, and 52% (13/25) by the neurology resident. Chi-squared analysis revealed no significant difference on three-way comparison, although there was a significant difference between the epileptologist and the neurology resident (p=0.037).
Conclusions:
Increased DSS incidence was seen in the TL-EC group compared to the non-TLEC group. Epileptologists may have a higher accuracy in identifying TLE-ECs on MRI compared to neurology residents.
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