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Temporal Lobectomy, Cognition and Behaviour: A Brief Review with Special Reference to the Requirements of Informed Consent

  • Graham E. Powell
  • Penny A. Murphy
  • Tom McMillan

Abstract

Temporal lobe epilepsy has been perceived as a clinical entity since the observations of Hughlings Jackson in 1888. It is characterised by a specific type of seizure involving a brief period of dazedness with confused or semipurposive behaviour and by masticatory or sniffing movements, and is preceded by auras of physical experience such as epigastric sensation or sensory hallucinations often of taste or smell (Falconer et al., 1955). In more severe cases, an attack may develop into a grand-mal seizure, but essentially temporal lobe seizures begin with epileptic discharges from foci in one or both of the temporal lobes. According to Falconer et al. (1955) a quarter to one third of all patients with epilepsy demonstrate such EEG phenomena. The identification of this type of seizure with temporal EEG foci paved the way for the operation of temporal lobectomy for intractable conditions, an operation pioneered in Canada by Wilder Penfield (e.g. Penfield & Steelman, 1947; Penfield & Flanigin, 1950). Penfield’s series began in 1939 and originally the excisions of the temporal lobe spared the deeper parts, notably the uncus, amygdala and hippocampus. In time, and with the development of centres in other parts of the world, the operation came to be carried out upon EEG evidence alone, whereas originally Penfield tended to operate only upon those with an abnormality visible at operation, and the operation resolved into a standard en bloc resection that removed between 5.5 and 6.5 cm from the temporal pole and included the mesial structures of amygdala, anterior hippocampus and uncus (Falconer, 1953; 1969). The specimen is removed as one piece (in contrast to the original suction technique) and is therefore available for pathological examination. Left and right hemisphere resections are identical except for the fact that the surgeon attempts to spare the posterior portion of the superior temporal gyrus of the dominant lobe in order to minimise the effects of the operation upon language.

Keywords

Temporal Lobe Temporal Lobe Epilepsy Superior Temporal Gyrus Focal Epilepsy Temporal Lobectomy 
These keywords were added by machine and not by the authors. This process is experimental and the keywords may be updated as the learning algorithm improves.

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Copyright information

© Springer Science+Business Media New York 1989

Authors and Affiliations

  • Graham E. Powell
  • Penny A. Murphy
  • Tom McMillan

There are no affiliations available

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