2026 Poster Presentations
P182: PEDIATRIC MIDDLE CRANIAL FOSSA ENCEPHALOCELES: OUR MANAGEMENT EXPERIENCE
Taylor Leavitt; Grace Anderson; Kaitlyn Brooks; Nathan Lindquist; Baylor College of Medicine
Introduction: Middle cranial fossa (MCF) encephaloceles are characterized by herniation of brain parenchyma through dural and bony defects in the lateral skull base. These are rare but may cause serious sequelae including cerebrospinal fluid (CSF) leak, meningitis, headaches, conductive hearing loss and seizures. Recently, temporal lobe encephaloceles have been recognized as a treatable form of focal pediatric epilepsy. However, there is a paucity of literature surrounding this topic; the goal of our study is to describe the demographics, encephalocele characteristics, and treatment outcomes for this patient population.
Methods: This is a single institution retrospective case series from 2010-2025 of children diagnosed with MCF encephaloceles. Patients 18 or younger with encephaloceles confined to the MCF were included. Anterior skull base encephaloceles were excluded. Demographic data, underlying causative pathology, imaging characteristics, and surgical findings were recorded. One-sided sign test was used to compare BMI of our cohort compared to national pediatric BMI averages.
Results: A total of 8 children, 5 (63%) male and 3 (38%) female, with lateral skull base encephaloceles were identified. Patient race/ethnicity was diverse, including 3 (38%) Hispanic children, 2 (25%) white non-Hispanic children, 2 (25%) Asian children, and 1 (12%) African American child. Median age at time of diagnosis was 10 years old. Median age-adjusted BMI was significantly higher when compared with their peers (93rd percentile; 95% CI: 75-99). Etiology of encephaloceles demonstrated 2 (25%) related to congenital/syndromic anomalies, 3 (38%) to cholesteatoma/iatrogenic causes and 3 (38%) spontaneous encephaloceles with no identifiable etiology. Location of encephaloceles included: 3 (38%) involving the tegmen mastoideum, 1 (13%)of the tegmen tympani, and 4 (50%) involving the infratemporal fossa. While 2 (25%) patients had epilepsy, the location of the encephalocele was not thought to be the foci of their seizures in either patient. 1 (13%) had cerebrospinal fluid leak. Of the 8 patients, 5 (63%) had encephaloceles surgically repaired, while observation was chosen for 3 (38%) patients. These patients had encephaloceles involving the infratemporal fossa that were asymptomatic, not thought to be the epileptic foci, and if surgically repaired would induce high morbidity. Of the 5 that were repaired, 4 (80%) had multilayered closure including fascia, bone graft, bone pate, cartilage, gelfoam, and fibrin glue.
Conclusion: Pediatric MCF encephaloceles are uncommon. We present a small case series of children from a diverse patient population with a variety of etiologies. Similar to adults, temporal lobe encephaloceles in pediatric patients is associated with high BMI. Both surgical intervention and observation may be employed in management of these patients based on clinical scenario and location of the defect. Multidisciplinary management is often warranted due to risk for epilepsy. Larger studies are needed to further characterize this patient population.