What is an anterior temporal lobectomy?

An anterior temporal lobectomy is a neurosurgical procedure for removing part of the temporal lobe in patients with severe, medication-resistant epilepsy. It is performed using a craniotomy on the side of the head. The incision begins in front of the ear and curves up toward the top of the head.

The goal of a temporal lobectomy is removal of part of the lateral temporal lobe, the temporal pole, and the mesial temporal structures including the hippocampus, amygdala, and uncus on one side of the brain. Below is a diagram from a book chapter I wrote that illustrates the part of the temporal lobe that is removed.

What are the surgery and recovery like?

Before we decide on surgery, extensive testing is performed to confirm that your seizures are arising from the temporal lobe and that you are not at risk of memory problems after the surgery. These tests generally include a video EEG, PET scan, neuropsychological testing, brain MRI, and, sometimes, SEEG. I will then meet you in the office to discuss surgery, along with benefits, risks, and alternatives. It is helpful to have a family member present, if possible.

You are admitted to the hospital on the morning of surgery. The procedure is performed under general anesthesia and lasts several hours. When the surgery is finished, I close your skin with absorbable sutures.

After the operation, you will wake up in the operating room and then be taken to the recovery area and then the neurologic intensive care unit. Most patients stay in the hospital two or three nights after the operation. Soreness on the side of the head and with chewing is common for several weeks.

You will see me and your neurologist in the office after the operation. Even if you are not having any seizures, we do not make changes to your anti-seizure medications for a year or so. After that, if you are still seizure-free, we may be able to reduce your doses or even eliminate one or more medications.

What are benefits and risks?

The primary benefit is a good chance of seizure freedom, and a very high chance of reducing your seizures. In large clinical series, the rate of seizure-freedom (a cure from seizures) with carefully selected patients who have a temporal lobectomy is roughly 70%. Indeed, randomized controlled trials have established that temporal lobectomy is superior to medications in patients with temporal lobe epilepsy.

Risks include continued seizures despite the operation (not every patient is cured). A worsening of memory is possible, and we screen patients with a careful neuropsychological examination to reduce this risk. It is expected to have a small area of visual loss in the periphery of your vision; most patients do not notice this until it is pointed out, and your central vision is not affected. Finally, there are serious risks of a craniotomy and general anesthesia, including a stroke and even death. Fortunately, these are very rare.