Temporal lobectomy for epilepsy — complicationsin 200 patients

doi:10.1016/S0967-5868(95)80009-3

Journal of Clinical Neuroscience

Volume 2, Issue 3, July 1995, Pages 238-244

https://doi.org/10.1016/S0967-5868(95)80009-3 Get rights and content

Abstract

At the Austin Hospital, Melbourne, Australia, 200 consecutive temporal lobectomies were performed for refractorycomplex partial seizures between 1969 and 1991 as part of its Comprehensive Epilepsy Program. The complications of this retrospective series are reported. There were no 30-day postoperative deaths but there were 6 late deaths. Complications are divided into ‘major’ if permanent and/or severe or ‘minor’ if temporary or not severe. Complications included hemiparesis (2% major, 1% minor), visual field defect (3% major, 18. 5% minor), dysphasia (96 dominant resections — 0% major, 5. 5% minor), memory impairment (1 % major, 9. 5% minor); intracranial infection (2% major, 0% minor), and miscellaneous (11 % minor). The mechanisms of the complications are discussed. Temporal lobectomy for the treatment of epilepsy can be performed with a low morbidity.

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Cited by (15)

Thirty-day non-seizure outcomes following temporal lobectomy for adult epilepsy
2017, Clinical Neurology and Neurosurgery
Citation Excerpt :
The limitations of these studies, particularly in regards to the NIS database and the systemic review by Hader et al., are well established and discussed above. A single center series of 200 TL cases reported 6 late deaths with no 30-day deaths, major (permanent and/or severe) neurological complication rates of 8%, and minor (temporary or not severe) complication rates of 45.5% [10]. Another single center study of 140 TL cases reported three major non-seizure complications (2.1%) and 15 minor non-seizure complications (10.7%) [8].
Multi-institutional rates of acute adverse outcomes other than seizures after temporal lobectomy (TL) are not well understood. Here we analyzed short-term morbidity and mortality following TL using a validated national database.
The multi-institutional American College of Surgeons National Surgical Quality Improvement Program (NSQIP) database was queried by Current Procedural Terminology (CPT) code for TL procedures performed for adult patients with diagnoses related to epilepsy from 2008 to 2014. Patient demographics, operative variables, hospital variables, preoperative laboratory values, and preexisting comorbidities were analyzed using univariate and multivariate techniques to determine associations with 30-day postoperative morbidity and mortality.
A total of 202 TL procedures were analyzed, 80 (39.6%) with intraoperative electrocorticography (ECOG) and 122 (60.4%) without ECOG. Mean age was 40.4 ± 13.7 years, and 47.5% of patients were male. Overall morbidity and mortality were 11.4% and 2.0%, respectively. The most common adverse outcomes were reoperation (5.4%), stroke with residual deficit (2.5%), failure to wean from ventilator (2.0%), and surgical site infection (2.0%). Adverse event rates were not significantly different between TLs with and without ECOG (13.1% vs. 8.8%, p = 0.375). Independent predictors of adverse events included prior stroke (OR 7.60, 95% CI 1.22–47.17, p = 0.029) and chronic steroid use (OR 10.90, 95% CI 1.03–115.79, p = 0.048). Diabetes mellitus (p = 0.078) and older age (p = 0.145) approached but did not reach significance in the multivariate model.
We report rates of acute morbidity and mortality following TL procedures using a national database. These findings can be used both to assist with patient selection as well as patient counseling prior to surgery.
Assessment of the Temporopolar Artery as a Donor Artery for Intracranial-Intracranial Bypass to the Middle Cerebral Artery: Anatomic Feasibility Study
2017, World Neurosurgery
Citation Excerpt :
In our extensive review of the literature, we did not come across any studies conclusively delineating the neurologic deficits associated with the occlusion of the TPA.12,13 However, extrapolating the available evidence from studies on clinical outcomes of anterior temporal lobectomies for temporal lobe epilepsy, one may deduce that the sacrifice of the arterial supply of the anterior temporal region (supplied by the distal ATA and TPA) is usually without major permanent neurologic complications.14-18 Alkadhi et al.7 reported 2 cases of aneurysms at the origin of the TPA.
Intracranial-intracranial bypass is a valuable cerebral revascularization option. Despite several advantages, one of the main shortcomings of the intracranial-intracranial bypass is the possibility of ischemic complications of the donor artery. However, when sacrificed, the temporopolar artery (TPA) is not associated with major neurologic deficits. We sought to define the role of TPA as a donor for revascularization of the middle cerebral artery (MCA).
Pterional craniotomy was performed on 14 specimens. The TPA was released from arachnoid trabecula, and the small twigs to the temporal lobe were cut. The feasibility of side-to-side and end-to-side bypass to the farthest arterial targets on insular, opercular, and cortical MCA branches was assessed. The distance of the bypass point was measured in reference to limen insulae.
A total of 15 TPAs were assessed (1 specimen had 2 TPAs). The average cisternal length of the TPA was 37.3 mm. For side-to-side bypass, the TPA was a poor candidate as an intracranial donor, except for the cortical orbitofrontal artery, which was reached in 87% of cases. However, the end-to-side bypass was successfully completed for most arteries (87%–100%) on the anterior frontal operculum and more than 50% of the cortical or opercular middle and posterior temporal arteries. There was no correlation between the TPA's cisternal length and maximum bypass reach.
When of favorable diameter, the TPA is a competent donor for intracranial-intracranial bypass to MCA branches at the anterior insula, and anterior frontal and middle temporal opercula (arteries anterior to the precentral gyrus coronal plane).
Anterior Temporal Artery-to-Anterior Cerebral Artery Bypass: Anatomic Feasibility of a Novel Intracranial-Intracranial Revascularization Technique
2017, World Neurosurgery
Complex aneurysms of the anterior cerebral artery (ACA) may require a bypass procedure as part of their surgical management. Most current bypass paradigms recommend technically demanding side-to-side anastomosis of pericallosal arteries or use of interposition grafts, which involve longer ischemia times. The purpose of this study is to assess the feasibility of an anterior temporal artery (ATA) to ACA end-to-side bypass.
Fourteen cadaveric specimens (17 ATAs) were prepared for surgical simulation. The cisternal course of the ATA was freed from perforating branches and arachnoid. The M3-M4 junction of the ATA was cut, and the artery was mobilized to the interhemispheric fissure. The feasibility of ATA bypass to the precommunicating and postcommunicating ACA was assessed in relation to the cisternal length and branching pattern of the middle cerebral artery.
Successful anastomosis was feasible in 14 ATAs (82%). Three ATAs did not reach the ACA. These ATAs were branching distally and originated from the M3 (opercular) middle cerebral artery. In specimens where bypass was not feasible, the average cisternal length of the ATA was significantly shorter than the rest.
ATA-ACA bypass is anatomically feasible and may be a useful alternative to other revascularization techniques in selected patients. It is technically simpler than A3-A3 in situ bypass. ATA-ACA bypass can be performed through the same pterional exposure used for the ACA aneurysms, sparing the patient an additional interhemispheric approach, required for the A3-A3 anastomosis.
Tailored cortical resection following image guided subdural grid implantation for medically refractory epilepsy
2009, Journal of Clinical Neuroscience
Citation Excerpt :
However the numbers of patients undergoing invasive monitoring and use of prophylactic antibiotics prior to or during the invasive monitoring period was unfortunately not commented on.21 Elsewhere infection following resective surgery has been reported as between 2% and 5%.34,35 The role of prophylactic dexamethasone administration during the period of monitoring with subdural grids is controversial.
The aim of this study was to report the safety and efficacy of tailored cortical resection based on image guided subdural electrode implantations in eight patients with medically refractory epilepsy. The patients were selected for multimodality image guided subdural grid implantation, inpatient invasive electroencephalography video monitoring and surgical resection of epileptogenic foci. All patients had frequent disabling, medically refractory seizures pre-operatively. At a minimum of 10 months post-resection all patients had a worthwhile improvement in seizure frequency, with 7 of the 8 (87.5%) having an excellent outcome (Engel Class I). Short-term complications of grid implantation were: one patient with a post-operative subdural haemorrhage and one patient with a transient fluctuating dysphasia. The only long-term complication was a mild, non-disabling dysarthria following resection near eloquent speech cortex in one patient. We conclude that tailored cortical resection following image-guided insertion of subdural grids is a reliable, safe and highly effective method for the treatment of medically refractory epilepsy in carefully selected patients.
Surgical treatment of epilepsy
2001, Neurologic Clinics
Citation Excerpt :
The risk of decline in naming is greater with more extensive resection of the lateral temporal neocortex.55 In addition to memory and language disturbances, hemiparesis, psychiatric disturbances, hematoma, meningitis, and diplopia caused by third or fourth cranial neuropathy have been reported after temporal lobe resection.12,91 Superior quadrant defects are found in over 50% of patients after ATL.12
Surgical approaches to mesial temporal structures for epilepsy: A personal view
2000, Journal of Clinical Neuroscience

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Clinical studyTemporal lobectomy for epilepsy — complicationsin 200 patients

Abstract

Am J Ophthalmol.

The structural basis of traumatic epilepsy and results of radical operation

Brain

Postoperative management and criteria for evaluation

Outcome with respect to epileptic seizures

The partial epilepsies

Temporal lobectomy in early childhood

Dev Med Child Neurol.

Temporal lobectomy — followup investigations of 74 temporal lobe resected patients

Acta Neurochir

Temporal lobectomy for partial complex seizures: evaluation, results, and one year followup

Neurology

Surgery for refractory epilepsy

Med J Aust

Surgical management of complex partial epilepsies

Surgical treatment of complex partial seizures: results, lessons and problems

Epilepsia

Wounds of the visual pathway

J Neurol Neurosurg Psychiatry

Complications of surgical procedures in the diagnosis and treatment of epilepsy

Results of surgical therapy for focal epileptic seizures

Can Med Assoc J

Type I complex partial seizures of hippocampal origin: excellent results of anterior temporal lobectomy

Neurology

A follow-up study of surgery in temporal lobe epilepsy

J Neurol Neurosurg Psychiatry

Appendix II: Presurgical Evaluation Protocols

Results of anterior temporal lobectomy that spares the amygdala in patients with complex partial seizures

J Neurosurg

Psychosocial difficulties and outcome after temporal lobectomy

Epilepsia

Localization of epileptic foci with postictal single photon emission computed tomography

Ann Neurol.

Chapter 5. The posterior division of the internal carotid artery

Microsurgical anatomy of the anterior choroidal artery

Surg Neurol.

Microsurgical anatomy of the hippocampal arteries

J Neurosurg.

Microvascular anatomy of the uncus and the parahippocampal gyrus

Neurosurgery

Clinical study
Temporal lobectomy for epilepsy — complicationsin 200 patients