Temporal Lobe Resection for Epilepsy

Temporal lobe resection, also called temporal lobectomy, is a surgery that can lower the number of seizures you have, make them less severe, or even stop them from happening. During the operation, the doctor removes some of the part of your brain where most seizures start.

Surgery isn't the first choice for treating epilepsy symptoms. But it may be an option if seizure medicines haven't worked for you or the side effects make them hard to take.

Tests Before Surgery

First, you'll have tests to help your doctor decide if the surgery can be done safely. Others tests map your brain to ensure only the part of your brain causing seizures gets removed.

Video EEG. You need to stay in the hospital for 3-5 days to have it done. You'll have EEG electrodes on your scalp while a camera records you. This allows doctors to match your brainwaves and activity during and between seizures to help figure out where in your brain they start. A video EEG doesn't hurt, and you can do most things normally while you have it.

SPECT scans and fMRI. These tests measure blood flow in your brain. They also help find where seizures start. You may get them after video EEG.

MEG. Similar to an EEG but more sensitive, this test helps to pinpoint the source of seizures. It also finds where your brain is active for speech and movement to protect those areas during your surgery. MEG uses an open scanner that fits over your head like a helmet. It takes an hour or two, but you'll have breaks in between scans.

Wada test. This tells which side of your brain controls language and which is better with memory.

During Surgery

Some of your hair might be clipped short or shaved right before surgery. You'll get medicine that puts you into a deep sleep.

The surgeon makes a cut in your scalp. She'll take out a small piece of bone to make a trap door perhaps a couple of inches on each side, and some of the membrane that covers your brain.

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If your seizures happen on the side of your brain that controls language, your surgeon might wake you briefly. You may need to count or answer a few questions to check that your speech is OK. Then you'll go back to sleep.

Using computer pictures, special microscopes, and an EEG that records your brainwaves, the surgeon zeroes in on and cuts out the source of your seizures, removing as little as possible.

She'll put the membrane and bone back, and close the cut.

After Surgery

The first day after surgery, you may be in the intensive care unit (ICU) so you can be watched closely. You could have swelling and bruising around your eye on the side where the surgery was done. This can last a few weeks. You may also have a headache, an earache, or a sore jaw.

You can usually eat and walk in a day or two and should be able to leave the hospital in less than a week. Most people slowly ease back into their lives over the next few months.

You'll need to keep taking seizure medicine until your doctor is sure your seizures are under control. In time, you may be able to take less or stop.

Epilepsy surgery is usually very successful, but it doesn't work for everyone. You may still have seizures.

Side Effects

The most common side effect is a small blind spot in your side vision, which isn't likely to bother you. You might also be queasy or throw up, or feel like you're going to have a seizure.

Some people have trouble speaking, or remembering or finding words. This often goes away on its own.

You may be more depressed or anxious after surgery. If your mood doesn't get better in a few weeks, talk to your doctor.

WebMD Medical Reference Reviewed by Neil Lava, MD on August 01, 2017

Sources

SOURCES:

Epilepsy Foundation: "Surgery," "Types of Surgeries," "Pre-Surgery Tests," "SPECT," "MEG (magnetoencephalography)," "Temporal Lobectomy," "Life After Surgery."

Columbia University Department of Neurological Surgery: "About Temporal Lobe Epilepsy."

University of Iowa Hospitals & Clinics: "Video EEG Monitoring Test (VEEG)."

Mayfield Brain & Spine: "Epilepsy surgery."

Epilepsy Society: "A closer look at MRI."

Canadian Journal of Neurological Sciences: "Functional MRI applications in epilepsy surgery."

UCSF Department of Radiology & Biomedical Imaging: "Magnetic Source Imaging (MSI) / Magnetoencephalography (MEG)."

Cleveland Clinic: "Wada Test."

UC San Diego Health: "Epilepsy Center: Surgery FAQ."

Journal of Neuroanaesthesiology & Critical Care: "Conscious sedation for epilepsy surgery."

Sutter Health CPMC: "Temporal Lobectomy."

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