Temporal lobe resections
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- Harkness, W. Childs Nerv Syst (2006) 22: 936. doi:10.1007/s00381-006-0140-5
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In the 50 years since Penfield outlined the requirements of the epilepsy surgeon, we have seen the introduction of the digitised electroencephalogram (EEG), video telemetry and the magnetic resonance imaging (MRI) scan. In the operating room, advances in neuro-anaesthesia, the introduction of the operating microscope, image guidance and the ultrasonic aspirator have greatly enhanced the surgeons’ technical ability. Despite these changes, the thesis encapsulated in Penfield’s statement is that the surgeon needs to understand and interpret the preoperative data in such a way as to identify as closely as possible the epileptogenic zone where he must carry out surgery with the utmost care and diligence, and finally, in the context of audit and follow-up of his surgical patients, he must be able to predict for each individual case the likelihood of success and failure of any particular procedure.
Previous articles in this supplement have looked at the specific investigations carried out to identify the epileptogenic zone, but once this data has been gathered, it is the responsibility of the neurosurgeon, within the context of the multidisciplinary team, to decide whether surgery is both feasible and advisable and then to discuss this in depth with the patient and their family and carers. The multidisciplinary epilepsy surgery meeting allows cases to be discussed in an open forum and the decisions made in this meeting can then be discussed with the family. The process of consent will begin from the moment any surgical procedure is discussed and should, wherever possible, be reinforced with written, as well as verbal, information. The process of consent should be a continuum until the actual day of surgery. All parties involved in the care and management of the patient should be regarded as stakeholders in this decision, and it is vital that all these stakeholders are working towards a common goal.
In this article, I will consider the specific aspects of the presurgical investigations that are applicable to the temporal lobe and the differing types of surgery that are likely to be indicated. I will then describe, in detail, the surgical technique of temporal lobe resection, highlighting some of the pitfalls and successes that such surgery can provide.