Epilepsy and Temporal Lobectomy Surgery
Author: Thomas C. Weiss : Contact: Disabled World
Published: 2010-01-20 : (Rev. 2017-11-11)
Synopsis and Key Points:
When epilepsy medications fail in controlling seizures one option is surgery known as temporal lobectomy.
The number of people who take medications to control seizures in the world is large, with many people benefiting from the medications available for seizure control. There are times when anti-seizure medications either do not work as well as they should, or at all where control over seizures related to epilepsy are concerned.
The effects on a person's life because of uncontrolled gran mal or other forms of seizures can be immense. When medications fail to assist in controlling seizures, one potential option is a surgery known as a, 'temporal lobectomy.'
A temporal lobectomy involves the removal of a portion of the person's temporal lobe of their brain. The surgery is the most common type of epilepsy surgery; it is also the most successful type of epilepsy surgery. There are a number of highly-skilled and qualified neurosurgeons who perform this type of surgery in America. Among people with epilepsy who have undergone this surgery. Sixty to seventy-percent become free of the seizures they experienced that caused abnormal movements, or impaired their consciousness. Some of these people still may experience things such as auras, or sensations like odors without an outside source.
Once the person who is having the surgery has both in position and asleep, the surgery starts. A patch of hair over the person's temple is shaved; fortunately it is not necessary to shave the person's entire head. Their skin is cut in a, 'C,' shaped partial circle above their ear. A number of nickel-sized holes are created in a circular pattern. The surgeon uses a saw to cut between the holes, removing a circle of bone approximately the size of the rim of a small coffee cup. Once the procedure is over, the person's bone is hard-wired back into place and eventually heals back into place in their skull. The wires that are used are non-magnetic and MRI compatible; they hold the person's bone in place and do not need to be removed.
The surgeon makes an incision in the person's membrane covering their brain, known as, 'dura matter,' exposing their temporal lobe. Portions of the person's temporal lobe are removed by suction; a person's brain has a more or less, 'firm pudding,' consistency. Different surgeons use various techniques and approaches depending upon their preferences and the ways they were trained. No one particular technique has been proven to be superior than another. The amount of matter removed commonly ranges from about the size of a golf ball to the size of a small lemon, representing less than half of the volume of the person's temporal lobe.
The portion of the person's brain that is removed during the surgery does not grow back. Instead, the space that it once occupied fills with the fluid which surrounds the person's brain. People sometimes wonder why replacement of seizure-producing scar with a surgical scar is beneficial. The reason why is because not every scar is alike. The scar left by neurosurgery is, 'clean,' meaning that it rarely leads to seizure activity. As surgeons end the surgery, they close the field of surgery in reverse order to that which they opened.
The person who has gone through a temporal lobectomy is usually in the operating room and recovery room for approximately four to eight hours, although sometimes they may be there longer. The majority of delays in returning from this form of surgery are due to administrative issues related to getting the operation started. Family members should not make the assumption that the surgery is the cause of a long wait. The operation itself commonly takes between two and three hours.
The person who has experienced this form of surgery might be disoriented for a day afterwards; family members need to be prepared for this eventuality. A headache is one of the clear issues associated with the surgery, but over-medicating the person is avoided because the person needs to be allowed to wake up. The person is commonly nauseated due to the anesthesia after the surgery, can have a sore throat because of the breathing tube, and will experience swelling and bruising on their forehead and eye on the side the surgery was performed. The swelling the person experiences peaks between two and four days after the surgery. The person who has had the surgery usually stays overnight in the hospital, or for two days in intensive care.
Commonly, by the third day after the surgery the person is able to sit up in a chair, walk unassisted, and eat. The person is given seizure medications intravenously until they can eat and drink. Not every anti-seizure medication has an intravenous form, so the person's medication may be temporarily switched. The person is usually discharged from the hospital within three to seven days after the surgery, and needs to plan on staying at home with assistance for approximately a week after that. They may need to stay off of work or refrain from heavy activity for a month. Some people who have a temporal lobectomy experience fatigue or a persistent headache and need two or three months of postoperative rest.
Complications can arise in approximately two-percent, or about one in every fifty people, who have a temporal lobectomy. The complications may be serious and can include:
- Death (0.1 - 0.5%)
- Reading difficulties
- Personality change
- Severe depression
- Partial loss of vision
- Psychiatric deterioration
- Severe speech problems
- Deterioration of memory ability
- Stroke, partial paralysis or numbness
There are some less serious complications that happen more frequently, to include deterioration of word-finding abilities, for a few months after surgery. People can experience pain and itching around the skin scar, particularly as it heals, infection of the surgical site, skull indentations or additional cosmetic defects, minor loss of upper peripheral vision on the side opposite the surgery, persistent headaches, transient depression, drooping of an eyelid or forehead on the surgical side, or a variety of other issues.
Seizure activity may flare up for a month or two after the person has surgery and their brain heals. The seizure activity during the postoperative months does not mean the operation was a failure; seizures may settle down as the person heals. It is important for people considering a temporal lobectomy to discuss both the potential benefits and the risks or the surgery with their surgeon.
Epilepsy surgery is successful approximately seventy-five percent of the time. People may be able to discontinue all of their medications, commonly about a year after surgery. Some people choose to continue taking anti-seizure medications. Others become free of seizure activity, yet still require medications. The benefits of surgery for epilepsy might fall short of a complete cure. People can still experience occasional auras or, breakthrough,' seizures during times of stress. Twenty-five percent of people do not respond favorably to surgery for epilepsy, commonly because not all of the focus could be removed, or because the seizures we multi-focal.
Twenty-to-twenty-five percent of people still experience some complex partial or tonic-clonic seizures, yet the number of seizures they experience is reduced by greater than eighty-five percent. Ten-to-fifteen-percent of people experience no worthwhile improvement whatsoever. What this means is that greater than eight-five-percent of people who have undergone a temporal lobectomy experience a great improvement in seizure control. Many people still need to continue taking anti-seizure medication, but usually have to take less of it. Approximately twenty-five percent of the people who have this form of surgery eventually are able to stop taking anti-seizure medications entirely.
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