Anterior temporal lobectomy

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Anterior temporal lobectomy
ICD-9-CM01.53
MeSHD038481

Anterior temporal

epileptic seizures, and who have frequent seizures, and who additionally qualify based on a WADA test to localize the dominant hemisphere for language module.[2]

Techniques

The techniques for removing temporal lobe tissue vary from resection of large amounts of tissue, including lateral temporal cortex along with medial structures, from using more restricted ATL to more restricted removal of only the medial structures (selective amygdalohippocampectomy).[3][4]

Nearly all reports of seizure outcome following these procedures indicate that the best outcome group includes patients with MRI evidence of

mesial temporal sclerosis (hippocampal atrophy with increased T-2 signal). The range of seizure-free outcomes for these patients is reported to be between 80% and 90%, which is typically reported as a sub-set of data within a larger surgical series.[5][6]

Risks and complications

Open surgical procedures such as ATL have inherent risks including damage to the brain (either directly or indirectly by injury to important blood vessels), bleeding (which can require re-operation), blood loss (which can require transfusion), and infection. Furthermore, open procedures require several days of care in the hospital including at least one night in an intensive care unit. Although such treatment can be costly, multiple studies have demonstrated that ATL in patients who have failed at least two anticonvulsant drug trials (thereby meeting the criteria for medically intractable temporal lobe epilepsy) has lower mortality, lower morbidity and lower long-term cost in comparison with continued medical therapy without surgical intervention.[7]

The strongest evidence supporting ATL over continued medical therapy for medically refractory temporal lobe epilepsy is a prospective, randomized trial of ATL compared to best medical therapy (anticonvulsants), which convincingly demonstrated that the seizure-free rate after surgery was about 60% as compared to only 8% for the medicine only group.

mesial temporal lobe epilepsy.[9]

Recovery

Recovery after ATL can take several weeks to months. Anti-seizure medications will be continued for several months after ATL. As it is an

hippocampus and contralateral hippocampus. In post-operative seizure free patients, NAA levels were significantly higher than post-operative non-seizure free patients and then returned to the normal level.[11]

History

ATL was popularised in the early 1980s and was found effective.[12]

References

  1. ^ "Epilepsy surgery, Temporal lobectomy, Vagus Nerve Stimulation". Cincinnati Ohio Mayfield Brain & Spine. Retrieved 20 January 2022.
  2. ^ "Wada Test". Epilepsy Foundation. Retrieved 20 January 2022.
  3. S2CID 25692616
    .
  4. ^ "Anteromedial Temporal Lobectomy". Neurosurgical Atlas. Retrieved 20 January 2022.
  5. PMID 8592530
    .
  6. .
  7. ^ "anterior_temporal_lobectomy". Operative Neurosurgery. Retrieved 7 January 2022.
  8. S2CID 31539171
    .
  9. .
  10. ^ "Recovery and Life After Surgery". Epilepsy Foundation. Retrieved 7 January 2022.
  11. PMID 12196667
    .
  12. .

External links