Abstract Details

Title Exploring Dural Sinus Stenosis Rates in Temporal Lobe Epilepsy With and Without Temporal Lobe Encephaloceles

Topic Epilepsy/Clinical Neurophysiology (EEG)

Presentation(s) P10 - Poster Session 10 (5:00 PM-6:00 PM)

Poster/Presentation
Number 9-007

Objective

- To compare dural sinus stenosis (DSS) rates in temporal lobe epilepsy (TLE) patients with temporal lobe encephalocele (TL-EC) vs without TL-EC

- To assess radiological identification rates of TL-EC by different physician types

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.

Authors/Disclosures
Sivani Lingam, MBBS (University of Kansas Medical Center) PRESENTER	Dr. Lingam has nothing to disclose.
Akshaya Prabhakaran Sudha, MBBS (University of Kansas Medical Center)	Dr. Prabhakaran Sudha has nothing to disclose.
William W. Liu, MD	Mr. Liu has nothing to disclose.
Vishal Shah, MBBS (University of Kansas Medical Center)	Dr. Shah has nothing to disclose.
Jennifer Cheng, MD (KU Medical Center)	Jennifer Cheng, MD has nothing to disclose.
Kelly Dahlstrom, DO	Dr. Dahlstrom has nothing to disclose.
Michael G. Abraham, MD (The University of Kansas Health System)	Dr. Abraham has received personal compensation in the range of $500-$4,999 for serving as a Consultant for Stryker Neurovascular.
Patrick Landazuri, MD, FAAN (University of Kansas - Department of Neurology - Comprehensive Epilepsy Center)	Dr. Landazuri has received personal compensation in the range of $500-$4,999 for serving as a Consultant for Neuropace. Dr. Landazuri has received personal compensation in the range of $500-$4,999 for serving on a Scientific Advisory or Data Safety Monitoring board for Neuropace. Dr. Landazuri has received personal compensation in the range of $500-$4,999 for serving as an Expert Witness for Federal Public Defender - District of Kansas. Dr. Landazuri has received publishing royalties from a publication relating to health care.

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