Temporal Lobe Epilepsy Caused by Unruptured Middle Cerebral Artery Aneurysms

THE SURGICAL therapy of temporal lobe epilepsy has achieved increasing importance as large series of good results have been reported.1-3Preoperative study of candidates for surgery has included pneumoencephalography (PEG) as the radiographic contrast examination of choice. Arteriography has been added only when thought specifically indicated. The pathological entities most often encountered in the resected temporal lobe have been mesial incisural sclerosis in approximately 50% of patients, cryptic tumors and vascular malformations in 20%, scars and infarcts in 15% and no definite pathology in 15%.4 In the last four years four patients with aneurysms of the middle cerebral artery had symptoms of temporal lobe epilepsy prior to rupture of the aneurysms. All were treated at the Neurological Institute of New York. These patients could not clinically be distinguished from other patients with idiopathic temporal lobe seizures. Diagnosis was established only by arteriographic study either before or after