Type of Surgery
Last updated: 02/17/2009
All surgical procedures are associated with risks and complications that vary depending on the location of the procedure (the approach and dissection required), the pathology (what has to be done to accomplish the surgical objective), and patient factors...
(such as age, general medical condition, etc.).
A specific risk associated with ATL is possible injury to the cerebral cortex, the outer portion of the brain that consists of layers of nerve cells and their connections, during the lobectomy procedure.
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.
Surgery for removal is generally advised for patients with limited cancer elsewhere in the body and a single brain metastasis.
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