Temporal Lobectomy

Temporal Lobectomy

Temporal Lobectomy

A temporal lobectomy is a surgical procedure whereby a portion of the temporal lobe of the brain is removed. The surgery generally targets lesions or scar tissue that are focal points for seizures.

Not everyone is a candidate for a temporal lobectomy. Many tests are required to identify the focal points from which seizures are emanating. If you are a candidate for this operation, the results are generally very good and the potential adverse events, while quite severe, are pretty rare.

Efficacy

According to epilepsy.com:
After surgery, 60% to 70% of patients are free of seizures that impair consciousness or cause abnormal movements. Some of these patients still experience auras, sensations (odors, for instance) without an outside source.

20% to 25% of patients still have some complex partial or tonic-clonic seizures but the number of seizures is reduced by more than 85%.

10% to 15% of patients have no worthwhile improvement.

This information, repeated in other authority sites on the internet, are generally based upon studies that only measured short term (up to 6 months) results. A longer term study shows that seizures can reoccur after a period of years, so this surgery may not be a permanent solution:

According to Brain, Vol. 127, No. 9, 2018-2030, September 2004 (Temporal lobectomy: long-term seizure outcome, late recurrence and risks for seizure recurrence):
The aim of this study was an in-depth examination of patterns of longitudinal outcome and potential risk factors for seizure recurrence after lobectomy, utilizing a large patient sample with long follow-up. Included were 325 patients who underwent anterior temporal lobectomy between 1978 and 1998 (mean follow-up 9.6 ± 4.2 years). Retrospective data were analysed using survival analysis and multivariate regression with Cox proportional hazard models. The probability of complete seizure freedom at 2 years post-surgery was 55.3% [95% confidence interval (CI) 50–61]; at 5 years, 47.7% (95% CI 42–53); and at 10 postoperative years it was 41% (95% CI 36–48).

I scored this a 9.4 for the chart because roughly 90% of patients achieve >50% reduction in seizures and roughly 40% of patients achieve >90% reduction in seizures.

Potential Adverse Events

According to Stanford University Medical Center (circa 2011 - link no longer available):
Complications occur in about two percent of patients (one-in-fifty) who have this surgery. Complications can be serious, including as a partial list:
  • Severe speech problems
  • Reading difficulties
  • Stroke, partial paralysis or numbness
  • Personality change
  • Deterioration of memory ability
  • Partial loss of vision
  • Psychiatric deterioration
  • Severe depression
  • Psychosis
  • Death (0.1 – 0.5%)
  • Others
According to Brain, Vol. 127, No. 9, 2018-2030, September 2004 (Temporal lobectomy: long-term seizure outcome, late recurrence and risks for seizure recurrence) (emphasis mine):
The results of this study indicate that the lack of an obvious abnormality or the presence of diffuse pathology, and preoperative secondarily generalized seizures are risk factors for recurrence after surgery. Late recurrence after initial seizure freedom is not a rare event; risk factors specific to this phenomenon are as yet unidentified.

I've scored this a 5 for adverse events because of the severity of the potential adverse events and the uncertainty regarding how long the results might last.

Cost

This procedure is cost prohibitive without insurance. It scores an 8 for a general approximation of out of pocket expenses (for what insurance does not cover).

Type

This is a one time procedure (hopefully!).

Latency

It can take 1-2 months for the brain to heal from the surgery and reductions in seizures are not expected until after that time. The best seizure control should occur from 2-3 months after the procedure to 2 years after. As time passes beyond that point, there is a possibility of seizures re-occurring. I scored this treatment with a 3 to indicate that efficacy does not appear to be stabilized until many years have passed.

This page last modified September 9, 2019.

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