To understand the relationship between skull base dehiscence and epilepsy. 

Encephaloceles are known contributors to epilepsy and are primarily documented in case reports and retrospective reviews of epilepsy cohorts. While these studies highlight the prevalence of encephaloceles in epilepsy, they provide limited insight into the risk of developing epilepsy in individuals with these defects. Our study seeks to address that gap.  

Retrospective chart review of patients age 18 or older with diagnosis of CSF leak or encephalocele with surgical repair or found on radiological study at our center between 1/1/2010 and 12/31/2021. Exclusion criteria included inadequate documentation of radiological findings, post-traumatic or iatrogenic cause of skull defect or CSF leak, or spinal CSF leak. Among these patients, individuals with history of epilepsy were identified, excluding those with a history of childhood epilepsy. 

137 patients with encephaloceles were identified. Of these, 17 developed epilepsy (12.4%). All 17 patients were female. Ten (59%) identified as African-American. Sixteen (94%) had a BMI of 30 or greater. The most common location of meningoencephalocele was in the middle cranial fossa (12 patients, 70%); followed by cribiform (3, 18%); both middle cranial fossa and cribiform (1, 6%); and in tegmen tympani and cribiform (1, 6%). Regarding laterality of meningoencephalocele, 7 were left-sided, 7 were right-sided, and 3 were bilateral. All patients except one also have radiological findings consistent with idiopathic intracranial hypertension (IIH).  

Meningoencephalocele-associated epilepsy has a moderate prevalence among all patients with skull base defects in our cohort. Among those with epilepsy and meningoencephalocele, female gender and elevated BMI are common. The location of meningoencephaloceles and radiological findings of increased intracranial pressure may differ between those who develop epilepsy and those who do not, warranting further study.