Objective: Temporal lobe meningoencephalocele is an unusual middle fossa herniation often requiring neurosurgical intervention (Wind, Caputy, & Roberti, 2008). Little neurocognitive data is available regarding the effects of the pathology and/or surgical repair. Thus, we review longitudinal findings in a patient with left temporal meningioencephalocele, highlighting surgical complications, neurocognitive outcomes, and key considerations for assessment methodology and clinical recommendations. Method: A 58-year-old, right-handed woman with 13 years of education presented with longstanding left ear CSF leak after an extended history of otitis media with hearing loss. Imaging revealed tegmental and middle fossa floor erosion with temporal herniation into left middle ear space, thought to be chronic. Surgical repair involved a small area of resection, and recovery was complicated by subdural hematoma (left greater than right with mild mass effect) requiring evacuation. The patient subsequently developed persistent concerns with memory, attention, practical executive functioning, and expressive language. Results: Despite significant improvements in the 3-year interval between assessments, profound impairment in sustained attention and difficulty adjusting to variable task demands remained, along with relative weaknesses in mental arithmetic, mental flexibility, language repetition, delayed list recall, and manual dexterity. Some degree of cognitive interference related to mild depression was evident. Conclusion: Significant recovery was demonstrated after a complicated history of left temporal meningioencephalocele. Deficits on follow-up were generally mild and congruent with clinical history, though prominent higher-level dysexecutive change remained disabling. This highlighted the importance of thoroughly assessing higher-order executive functions in a predominantly left temporal pathology, findings from which significantly shaped clinical recommendations for this patient.