Type of Surgery
Last updated: 02/17/2009
After ATL surgery, the neurosurgeon provides instructions for the nurses, pharmacists, therapists, and other physicians caring for the patient postoperatively. Once the anesthesiologist determines that the patient is stable, the surgeon authorizes...
transport to the postoperative care area. Most patients go to the recovery area, but some critical patients may be taken to an intensive care unit (ICU) for close monitoring. As is the case for almost all types of brain surgery, the patient is initially nursed with the head of the bed elevated to 30 degrees.
Anterior temporal lobectomy is the complete removal of the anterior portion of the temporal lobe of the brain. It is a treatment option in temporal lobe epilepsy for those in whom anticonvulsant medications do not control epileptic seizures.
The techniques for removing temporal lobe tissue vary from resection of large amounts of tissue, including lateral temporal cortex along with medial structures, to more restricted anterior temporal lobectomy (ATL) to more restricted removal of only the medial structures (selective amygdalohippocampectomy, SAH).
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.
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. Such treatment is quite costly; a factor that may influence some health care systems to avoid referral to qualified centers.
However, a prospective, randomized trial of ATL compared to best medical therapy (anticonvulsants) demonstrated that the seizure-free rate after surgery was ~ 60% as compared to only 8% for the medicine only group. Therefore, ATL is considered the standard of care for patients with medically-intractable mesial temporal lobe epilepsy.
Select comparative data from 1999 to 2006 include a decrease of 14 percent in the number of neurosurgeons in private practice and a decrease of 13 percent in the number of neurosurgeons in solo practice.
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