Awake resection of temporal encephalocele associated with drug-resistant epilepsy: illustrative case

Background: The association between temporal encephaloceles (TEs) and drug-resistant epilepsy (DRE) is well recognized, yet the literature regarding therapeutic management remains scarce and largely retrospective. Reported strategies vary from conservative approaches to extensive resection of encephaloceles including the adjacent epileptogenic zone (EZ). Surprisingly, although the EZ may be localized within or adjacent to eloquent areas, surgeries under awake conditions have not been described. One plausible explanation is the potential risk of intraoperative pain during surgical manipulation in the area of the richly innervated basal dura.