A temporal lobe resection is a surgery performed on the temporal lobe of the brain to resect, or cut away, the seizure focus to control epilepsy. A temporal lobe resection is an option for people with temporal lobe epilepsy whose seizures are disabling or refractory (not controlled by anticonvulsants). Two single anti-seizure medications and a combination of two or more drugs should be tried before surgery is considered. The goal of a resection is to remove all of the seizure focus without causing any loss of brain function.
How does a Person Become a Candidate for a Resection?
People with refractory temporal lobe epilepsy are thoroughly evaluated to identify an area of the brain that, if removed, will lead to seizure freedom. It must be possible to remove the epileptogenic zone (area causing the seizures) without causing damage to the areas of the brain responsible for vital functions, such as memory, movement, sensation, and language. When a benign tumor or hippocampal sclerosis (an area of cell loss in the hippocampus which lies deep within each temporal lobe) is discovered, its removal leads to an increased rate of seizure elimination.
Part of the evaluation may be intracranial EEG which is recorded from electrodes placed on or in the brain to record the electrical activity directly from the brain. The electrodes are surgically placed where the epileptic focus is thought to be. Intracranial recordings are continuously made when the patient is awake, asleep, and during seizures to pinpoint where the seizures begin.
To learn how a temporal lobe resection differs from another surgical procedure, a VNS implant, read our blog, "Take Heart: New VNS Implant May Reduce Seizures for Epileptics".
What Happens in Surgery?
During the surgery, a craniotomy is performed to expose the cortex. The neurosurgeon uses information gathered prior to the surgery to pinpoint the epileptogenic zone, surgical microscopes and information recorded during the surgery to guide the resection. A temporal lobectomy is the most common type of surgery. The surgeon removes 4 to 6 centimeters of the anterior temporal lobe usually along with the amygdala and hippocampus. After the brain tissue is removed, the skull bone is fixed back into place and the scalp is closed.
How Long does Recovery Take?
The patient stays in the hospital for two to four days and is able to return to normal activities in six to eight weeks after surgery. Most patients continue to take anti-seizure medication immediately after surgery. Once seizure control is established, medications may be reduced or totally eliminated.
The complication rate of a temporal lobe resection is low with the most frequent complication being a visual field defect (loss of part of the usual field of vision).
What are the Possible Outcomes for Epilepsy Surgery?
Studies have shown that a temporal lobe resection is successful in eliminating (being seizure-free for one year) or significantly reducing seizures in 60% to 90% of patients. For those who have suffered from uncontrollable seizures for years, a resection may be an option that provides relief.
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Author: Lucy Sullivan, R. EEG T., CLTM
Lucy has more than 42 years of EEG experience, having served as Program Director of an accredited EEG school, Supervisor of an EEG Department at Children’s Hospital in Pittsburgh, and Director of Publications for ASET which included Managing Editor of The Neurodiagnostic Journal. She has expertise in EEG and long-term monitoring for epilepsy including invasive EEG and accomplishments have included receiving the Maureen Berkeley Award for the outstanding technologist article in The Neurodiagnostic Journal and the Theda Sannit Award for outstanding neurodiagnostic educator. Lucy was trained in EEG at the University of Wisconsin – Madison. Lucy joined RSC's team in February 2016 and we are delighted to have her join RSC's effort to Redefine Seizure Care.