Overview
Temporal Lobectomy
Temporal lobectomy is the removal of a portion of the temporal lobe of the brain. It is the most common type of epilepsy surgery and is also the most successful type. Temporal lobectomy surgery has been recognized as an efficient treatment option for certain types of seizures in patients diagnosed with temporal lobe epilepsy (TLE). Characterized by transient disturbances of brain function and seizures, TLE is the most common form of epilepsy.Diagnosis/Preparation
An ATL pre-surgical diagnosis requires reliable diagnostic levels classified as (1) seizure, (2) epilepsy, and (3) syndrome. The epilepsy and syndromic diagnoses are usually combined. The seizure diagnosis is determined from the physical and neurological manifestations of the condition recorded in the patient's history and from electroencephalogram (EEG) evaluations. Because seizures commonly result from cortical damage, neuroimaging techniques are used to identify and localize the damaged area.They include: -
- Magnetic resonance imaging (MRI). Brain MRI is the best structural imaging technique available. Every ATL surgical evaluation usually includes a complete MRI study.
- Positron emission tomography (PET). Unlike MRI, PET provides information on brain metabolism rather than on structure. Typically, the epileptic region's metabolism is lowered unless the scan is obtained during a seizure.
- Single photon emission tomography (SPECT). SPECT scans visualize blood flow through the brain and are used as another method for localizing the epileptic site.
- Anesthesia. The patient is anesthetized with a combination of drugs that achieves a state of unconsciousness.
- Preparation of the surgical field. An antiseptic solution is applied to the patient's scalp, face, and neck. Surgical drapes are placed around the surgical region to maintain a sterile surgical field.
- Temporal incision. Using a scalpel blade, the neurosurgeon makes an incision in the skin and muscle of the temporal region of the head located on the side of the head above the ear, and pulls away the flap of scalp.
- Control of bleeding. Blood obstructing the surgeon's view of the surgical field is irrigated and suctioned away as surgery proceeds.
- Craniotomy. Using a high-speed drill, the neurosurgeon removes a section of bone (bone flap) from the skull and makes an incision through the protective membranes of the brain (dura) in order to expose the temporal lobe.
- Removal of the anterior lobe. Using an operating microscope to enlarge the features of the surgical area, the neurosurgeon removes the temporal anterior lobe.
- Closure. Once bleeding is under control, every layer of tissue cut or divided to reach the surgical site is closed. The cavity is irrigated completely and the dura is closed in a watertight manner using tack-up sutures. The bone flap is returned into place. Muscle and tissues are closed with sutures, while the skin is closed with staples. No drain is needed.
Complications Of Temporal Lobectomy
Complications occur in about two percent of patients (one-in-fifty) who have this surgery. Complications can be serious, including as a partial list: -- Severe speech problems
- Reading difficulties
- Stroke, partial paralysis or numbness
- Personality change
- Deterioration of memory ability
- Partial loss of vision
- Psychiatric deterioration
- Severe depression
- Psychosis
- Death (0.1 - 0.5%)
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