Temporal lobe encephaloceles (TLENs) are herniations of brain tissue through defects in the dura, often associated with conditions including elevated intracranial pressure, trauma, cerebrospinal fluid leak, and epilepsy. TLENs are frequently underdiagnosed, particularly in epilepsy patients, due to their subtle appearance on imaging and their location in the middle cranial fossa, delaying the diagnosis of this surgically treatable condition. This pictorial review will focus on the typical imaging appearance of TLENs in epilepsy patients, classic and unusual locations of TLENs associated with epilepsy, and related imaging features, such as those of idiopathic intracranial hypertension. We will also discuss some challenges and pitfalls that may lead to misdiagnosis and consider the tools and techniques which may help confirm the diagnosis.

Conflict of interest The authors declare the following financial interests/personal relationships which may be considered as potential competing interests: Aline Herlopian reports relationships with the following: Medtronic that includes consulting or advisory; UCB Pharma SA that includes consulting or advisory; Springer Nature that includes speaking and lecture fees; and Natus Medical Inc that includes speaking and lecture fees. If there are other authors, they declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper.