Type of Surgery
Last updated: 02/17/2009
Chilton, L. Seizure Free: From Epilepsy to Brain Surgery, ISurvived, and You Can, Too! Dallas: English Press Publications, 2000.
Freeman, J. M., E. P. G. Vining, and D. J. Pillas. Seizures andEpilepsy...
in Childhood: A Guide. Baltimore: Johns Hopkins University Press, 2002.
Hauser, W. A. and D. C. Hesdorffer. Epilepsy: Frequency,Causes, and Consequences. New York: Demos Publications, 1990.
Waltz, M. Partial Seizure Disorders: Help for Patients andFamilies. Sebastopol, CA: Patient-Centered Guides, 2001.
Clusmann, H., J. Schramm, T. Kral, C. Helmstaedter, B. Ostertun, R. Fimmers, D. Haun, and C. E. Elger. "Prognostic factors and outcome after different types of resection for temporal lobe epilepsy."Journal of Neurosurgery 97 (November 2002): 1131โ1141.
Crino, P. B. "Outcome Assessment of Anterior Temporal Lobectomy."Epilepsy Quartely 5 (Spring 1997): 1โ4.
Elwes, R. D., G. Dunn, C. D. Binnie, and C. E. Polkey. "Outcome following resective surgery for temporal lobe epilepsy: a prospective follow up study of 102 consecutive cases."Journal of Neurology, Neurosurgery and Psychiatry 54 (1991): 949โ952.
Jarrar, R. G., J. R. Buchhalter, F. B. Meyer, F. W. Sharbrough, and E. Laws. "Long-term follow-up of temporal lobectomy in children."Neurology 59 (November 2002): 1635โ1637.
Jones, J. E., N. L. Berven, L. Ramirez, A. Woodard, B. P. Hermann. "Long-term psychosocial outcomes of anterior temporal lobectomy."Epilepsia 43 (August 2002): 896โ903.
Radhakrishnan, K., E. L. So, P. L. Silbert, G. D. Cascino, W. R. Marsh, R. H. Cha, and P. C. O'Brien. "Prognostic implications of seizure recurrence in the first year after anterior temporal lobectomy."Epilepsia 44 (January 2003): 77โ80.
Sperling, M. R., M. J. O'Connor, A. J. Saykin, and C. Plummer. "Temporal lobectomy for refractory epilepsy."Journal of the American Medical Association 276 (1996): 470โ475.
Zimmerman, R. S. and J. I. Sirven. "An overview of surgery for chronic seizures."Mayo Clinic Proceedings 78 (January 2003): 109โ117.
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.
Find a Qualified Specialist
Looking for a specialist?
Please enter your zip code.