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Anterior temporal lobectomy

December 20, 2023

Anterior temporal lobectomy is the complete or partial removal of the anterior portion of the temporal lobe of the brain. The exact boundaries for removal can vary slightly in practice and between neurosurgeons.[1] It is a treatment option for temporal lobe epilepsy for those in whom anticonvulsant medications do not control 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]

Anterior temporal lobectomy
ICD-9-CM01.53
MeSHD038481
[edit on Wikidata]

Techniques edit

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 anterior temporal lobectomy (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/Complications edit

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 ~ 60% as compared to only 8% for the medicine only group.[8] Furthermore, there was no mortality in the surgery group, while there was seizure-related mortality in the medical therapy group. Therefore, ATL is considered the standard of care for patients with medically intractable mesial temporal lobe epilepsy.[9]

Recovery edit

Recovery after ATL can take several weeks to months. Anti-seizure medications will be continued for several months after ATL. As it is an open surgery it takes time for the brain to heal.[10] Speech therapy, occupational therapy, etc can help you recover. About 90% of people experience an improvement in seizures after temporal lobectomy. In mesial temporal lobe epilepsy, NAA(N-Acetyl Aspartate) has reduced concentration in epileptogenic 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 edit

Anterior temporal lobectomy (ATL) was popularised in the early 1980s and was found effective.[12]

References edit

  1. ^ "Epilepsy surgery, Temporal lobectomy, Vagus Nerve Stimulation | Cincinnati Ohio Mayfield Brain & Spine". mayfieldclinic.com. Retrieved 2022-01-20.
  2. ^ "Wada Test". Epilepsy Foundation. Retrieved 2022-01-20.
  3. ^ Bonilha, Leonardo; Yasuda, Clarissa Lin; Rorden, Chris; Li, Li M.; Tedeschi, Helder; de Oliveira, Evandro; Cendes, Fernando (March 2007). "Does resection of the medial temporal lobe improve the outcome of temporal lobe epilepsy surgery?". Epilepsia. 48 (3): 571–578. doi:10.1111/j.1528-1167.2006.00958.x. ISSN 0013-9580. PMID 17326795. S2CID 25692616.
  4. ^ "Anteromedial Temporal Lobectomy". www.neurosurgicalatlas.com. Retrieved 2022-01-20.
  5. ^ Engel J (March 1996). "Surgery for seizures". The New England Journal of Medicine. 334 (10): 647–52. doi:10.1056/nejm199603073341008. PMID 8592530.
  6. ^ Spencer SS, Berg AT, Vickrey BG, Sperling MR, Bazil CW, Shinnar S, Langfitt JT, Walczak TS, Pacia SV (September 2005). "Predicting long-term seizure outcome after resective epilepsy surgery: the multicenter study". Neurology. 65 (6): 912–8. doi:10.1212/01.wnl.0000176055.45774.71. PMID 16186534. S2CID 24280239.
  7. ^ "anterior_temporal_lobectomy [Operative Neurosurgery]". operativeneurosurgery.com. Retrieved 2022-01-07.
  8. ^ Wiebe S, Blume WT, Girvin JP, Eliasziw M (August 2001). "A randomized, controlled trial of surgery for temporal-lobe epilepsy". The New England Journal of Medicine. 345 (5): 311–8. doi:10.1056/NEJM200108023450501. PMID 11484687. S2CID 31539171.
  9. ^ Muzumdar, Dattatraya; Patil, Manoj; Goel, Atul; Ravat, Sangeeta; Sawant, Nina; Shah, Urvashi (2016-12-01). "Mesial temporal lobe epilepsy – An overview of surgical techniques". International Journal of Surgery. Epilepsy surgery for pharmacoresistant epilepsy. 36 (Pt B): 411–419. doi:10.1016/j.ijsu.2016.10.027. ISSN 1743-9191. PMID 27773861.
  10. ^ "Recovery and Life After Surgery". Epilepsy Foundation. Retrieved 2022-01-07.
  11. ^ Vermathen, P.; Ende, G.; Laxer, K.D.; Walker, J.A.; Knowlton, R.C.; Barbaro, N.M.; Matson, G.B.; Weiner, M.W. (2002-08-27). "Temporal lobectomy for epilepsy: Recovery of the contralateral hippocampus measured by 1H MRS". Neurology. 59 (4): 633–636. doi:10.1212/wnl.59.4.633. ISSN 0028-3878. PMC 2753242. PMID 12196667.
  12. ^ Van Gompel, Jamie J.; Ottman, Ruth; Worrell, Gregory A.; Marsh, W. Richard; Wetjen, Nicholas M.; Cascino, Gregory D.; Meyer, Fredric B. (November 2012). "Use of Anterior Temporal Lobectomy for Epilepsy in a Community-Based Population". Archives of Neurology. 69 (11): 1476–1481. doi:10.1001/archneurol.2012.1200. ISSN 0003-9942. PMC 3526693. PMID 22911042.

External links edit

  • Surgery Encyclopedia: Anterior temporal lobectomy

December 20, 2023
anterior, temporal, lobectomy, complete, partial, removal, anterior, portion, temporal, lobe, brain, exact, boundaries, removal, vary, slightly, practice, between, neurosurgeons, treatment, option, temporal, lobe, epilepsy, those, whom, anticonvulsant, medicat. Anterior temporal lobectomy is the complete or partial removal of the anterior portion of the temporal lobe of the brain The exact boundaries for removal can vary slightly in practice and between neurosurgeons 1 It is a treatment option for temporal lobe epilepsy for those in whom anticonvulsant medications do not control 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 Anterior temporal lobectomyICD 9 CM01 53MeSHD038481 edit on Wikidata Contents 1 Techniques 2 Risks Complications 3 Recovery 4 History 5 References 6 External linksTechniques editThe 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 anterior temporal lobectomy 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 Complications editOpen 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 60 as compared to only 8 for the medicine only group 8 Furthermore there was no mortality in the surgery group while there was seizure related mortality in the medical therapy group Therefore ATL is considered the standard of care for patients with medically intractable mesial temporal lobe epilepsy 9 Recovery editRecovery after ATL can take several weeks to months Anti seizure medications will be continued for several months after ATL As it is an open surgery it takes time for the brain to heal 10 Speech therapy occupational therapy etc can help you recover About 90 of people experience an improvement in seizures after temporal lobectomy In mesial temporal lobe epilepsy NAA N Acetyl Aspartate has reduced concentration in epileptogenic 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 editAnterior temporal lobectomy ATL was popularised in the early 1980s and was found effective 12 References edit Epilepsy surgery Temporal lobectomy Vagus Nerve Stimulation Cincinnati Ohio Mayfield Brain amp Spine mayfieldclinic com Retrieved 2022 01 20 Wada Test Epilepsy Foundation Retrieved 2022 01 20 Bonilha Leonardo Yasuda Clarissa Lin Rorden Chris Li Li M Tedeschi Helder de Oliveira Evandro Cendes Fernando March 2007 Does resection of the medial temporal lobe improve the outcome of temporal lobe epilepsy surgery Epilepsia 48 3 571 578 doi 10 1111 j 1528 1167 2006 00958 x ISSN 0013 9580 PMID 17326795 S2CID 25692616 Anteromedial Temporal Lobectomy www neurosurgicalatlas com Retrieved 2022 01 20 Engel J March 1996 Surgery for seizures The New England Journal of Medicine 334 10 647 52 doi 10 1056 nejm199603073341008 PMID 8592530 Spencer SS Berg AT Vickrey BG Sperling MR Bazil CW Shinnar S Langfitt JT Walczak TS Pacia SV September 2005 Predicting long term seizure outcome after resective epilepsy surgery the multicenter study Neurology 65 6 912 8 doi 10 1212 01 wnl 0000176055 45774 71 PMID 16186534 S2CID 24280239 anterior temporal lobectomy Operative Neurosurgery operativeneurosurgery com Retrieved 2022 01 07 Wiebe S Blume WT Girvin JP Eliasziw M August 2001 A randomized controlled trial of surgery for temporal lobe epilepsy The New England Journal of Medicine 345 5 311 8 doi 10 1056 NEJM200108023450501 PMID 11484687 S2CID 31539171 Muzumdar Dattatraya Patil Manoj Goel Atul Ravat Sangeeta Sawant Nina Shah Urvashi 2016 12 01 Mesial temporal lobe epilepsy An overview of surgical techniques International Journal of Surgery Epilepsy surgery for pharmacoresistant epilepsy 36 Pt B 411 419 doi 10 1016 j ijsu 2016 10 027 ISSN 1743 9191 PMID 27773861 Recovery and Life After Surgery Epilepsy Foundation Retrieved 2022 01 07 Vermathen P Ende G Laxer K D Walker J A Knowlton R C Barbaro N M Matson G B Weiner M W 2002 08 27 Temporal lobectomy for epilepsy Recovery of the contralateral hippocampus measured by 1H MRS Neurology 59 4 633 636 doi 10 1212 wnl 59 4 633 ISSN 0028 3878 PMC 2753242 PMID 12196667 Van Gompel Jamie J Ottman Ruth Worrell Gregory A Marsh W Richard Wetjen Nicholas M Cascino Gregory D Meyer Fredric B November 2012 Use of Anterior Temporal Lobectomy for Epilepsy in a Community Based Population Archives of Neurology 69 11 1476 1481 doi 10 1001 archneurol 2012 1200 ISSN 0003 9942 PMC 3526693 PMID 22911042 External links editSurgery Encyclopedia Anterior temporal lobectomy Retrieved from https en wikipedia org w index php title Anterior temporal lobectomy amp oldid 1189723638, wikipedia, wiki, book, books, library,

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