Type of Surgery
Last updated: 02/17/2009
Epilepsy is the most common serious neurological condition in the United States. Its incidence is greatest in young chidren and in the elderly, with five to 10 cases diagnosed per 1,000. The lifetime prevalence amounts to 2â€“5% of the population....
Epilepsy is slightly more common in males than females. The frequency of seizure activity in the epileptic population is as follows.
- 33% have less than one seizure per year
- 33% have one to 12 seizures per year
- 33% have more than one seizure per month
- 60% also have other neuropsychiatric problems
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.
On neurosurgery it is important to have new types of procedures, like stereotactic radiosurgery that is a newer type of focused radiation that has been used with some success for patients with metastatic brain tumors
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