Risks and complications
|Temporal lobectomy||Surgical indications
Prep and drape
Risks and complications
|Surgical indications||Some seizure disorders result from pathology (disease, abnormality) in the medial portion of the temporal lobe.
Patients with intractable epilepsy by history and neurologic examination with diagnostic study: (MR brain temporal sclerosis, Electroencephalogram (EEG)) consistent with epilepsy.
|Surgical objectives||Complete resection of the portion of the temporal lobe that is causing seizures requires very precise identification of important structures in order to completely remove the seizure focus without injury to nearby important structures.|
|Lesion considerations||temporal lobectomy|
|Exposure||temporal lobectomy. Temporal exposure|
|Approach||temporal lobectomy. Temporal approach|
|Landmarks||temporal lobectomy. Temporal line. Tragus of ear. Coronal suture. Zygoma.|
|Hazards||Structures along the course of the approach that might be injured during the exposure during temporal lobectomy
Once the dura is open and reflected to the side of the surgical field, the cortical surface (frontal and temporal lobes) is visualized.
Resection of temporal lobe is limited by the Sylvian fissurewhich is the boundary between the temporal and frontal lobes. From its anterior tip, a limited amount of temporal lobe can be resected without causing the patient neurologic deficit.
Language function is controlled by the more posterior portion of the temporal lobe primarily on the left side. It is recommended that no more than the anterior 5 cm of temporal lobe be removed on the patient’s left (language controlling) side. On the right side, more temporal lobe (up to 7 cm) can be taken without undue risk of language or other neurologic deficit.
in some patients important language functions are controlled by more anterior portions of the temporal lobe. Conservative resection of only the anterior 5 cm of temporal lobe can result in language problems in some patients. The right temporal lobe has more significant language functions in some patients who can suffer language problems or other neurologic deficits even by limiting lobectomy to the anterior 7 cm.
|Instruments||temporal lobectomy. Craniotomy tray. Scalp clips. Perforator. Craniotome.|
|Anesthesia||General anesthesia is usually used for temporal lobectomy.|
|Position||Supine is the usual position for temporal lobectomy.|
|Prep and drape||The patient is prepped and draped as if for a standard craniotomy unless surgery is done with the patient awake or if there is cortical mapping.|
|Target manipulation||temporal lobectomy|
|Problems||Problems that can arise during surgery include _____ (bleeding, loss of orientation, contamination of field, etc.) temporal lobectomy|
A temporal lobectomy takes approximately ___ hours:
|Post Op||After temporal lobectomy the patient is usually taken to Recovery. Immediately post operatively the patient is monitored for… for a duration of …
Once recovered the patient is ____.
|Follow up||After discharge from the post surgical unit (home, long term care facility, etc.) the patient following ____ should be seen by a member of the surgical team within ____.
Rehabilitation (therapy – speech, occupational, physical)
Rehabilitation is (sometimes, always, never, rarely) indicated following ____.
|Risks & complications||temporal lobectomy|