Anterior Temporal Lobectomy Health Article

Definition

An anterior temporal lobectomy (ATL) is the complete removal of the anterior portion of the temporal lobe of the brain.

Purpose

ATL surgery has been recognized as an efficient treatment option for certain types of seizures in patients diagnosed with temporal lobe epilepsy (TLE). Characterized by transient disturbances of brain function and seizures, TLE is the most common form of epilepsy. ATL is optimal for patients with seizures that do not respond to medications, patients who are unable to tolerate medication side effects, or patients with seizures caused by structural abnormalities in the brain.

Demographics

Epilepsy is the most common serious neurological condition in the United States. Its incidence is greatest in young chidren and in the elderly, with five to 10 cases diagnosed per 1,000. The lifetime prevalence amounts to 2–5% of the population. Epilepsy is slightly more common in males than females. The frequency of seizure activity in the epileptic population is as follows.

• 33% have less than one seizure per year
• 33% have one to 12 seizures per year
• 33% have more than one seizure per month
• 60% also have other neuropsychiatric problems

Description

ATL surgical procedures:

• Anesthesia. The patient is anesthetized with a combination of drugs that achieves a state of unconsciousness.
• Preparation of the surgical field. An antiseptic solution is applied to the patient's scalp, face, and neck. Surgical drapes are placed around the surgical region to maintain a sterile surgical field.
• Temporal incision. Using a scalpel blade, the neurosurgeon makes an incision in the skin and muscle of the temporal region of the head located on the side of the head above the ear, and pulls away the flap of scalp.
• Control of bleeding. Blood obstructing the surgeon's view of the surgical field is irrigated and suctioned away as surgery proceeds.
• Craniotomy. Using a high-speed drill, the neurosurgeon removes a section of bone (bone flap) from the skull and makes an incision through the protective membranes of the brain (dura) in order to expose the temporal lobe.
• Removal of the anterior lobe. Using an operating microscope to enlarge the features of the surgical area, the neurosurgeon removes the temporal anterior lobe.
• Closure. Once bleeding is under control, every layer of tissue cut or divided to reach the surgical site is closed. The cavity is irrigated completely and the dura is closed in a watertight manner using tack-up sutures. The bone flap is returned into place. Muscle and tissues are closed with sutures, while the skin is closed with staples. No drain is needed.