Temporal lobectomy

Neurosurgical procedures

Risks and complications

Temporal lobectomy Surgical indications

Surgical objectives

Lesion considerations

Exposure

Approach

Landmarks

Hazards

Instruments

Anesthesia

Monitoring

Position

Prep and drape

Incision

Dissection

Target manipulation

Problems

Hemostasis

Closure

Duration

Post Op

Recovery

Rehabilitation

Follow up

Reoperation

Risks and complications

Prognosis

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 lineTragus 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.
 
Monitoring 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.
 
Incision temporal lobectomy
 
Dissection temporal lobectomy
 
Target manipulation temporal lobectomy
 
Problems Problems that can arise during surgery include _____ (bleeding, loss of orientation, contamination of field, etc.) temporal lobectomy
 
Hemostasis temporal lobectomy
 
Closure temporal lobectomy
 
Duration temporal lobectomy

A temporal lobectomy takes approximately ___ hours:
induction (Anesthesia)
positioning (for required exposure)
prep
exposure
target
closure
extubation

 
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 ____.

temporal lobectomy

 
Recovery temporal lobectomy
 
Rehabilitation temporal lobectomy
 
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 ____.
 
Reoperation temporal lobectomy
 
Risks & complications temporal lobectomy
 
Prognosis temporal lobectomy