Indications
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Treatment option in temporal lobe epilepsy for patients in whom anticonvulsant medications do not control epileptic seizures
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Techniques for removing temporal lobe tissue, such as in anterior temporal lobectomy, and for more restricted removal of only the medial structures, such as in selective amygdalohippocampectomy
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Treatment of temporal brain tumors, including intraventricular tumors in the anterior temporal horn or intraaxial temporal lobe tumors such as intrinsic glioma
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Treatment of temporal lobe lesions of unknown etiology, such as an infection
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Treatment of trauma to the middle meningeal injury with epidural hematoma, subdural component, and temporal lobe contusions
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Treatment of vascular lesions, such as aneurysms, arteriovenous malformations, and cavernomas
Contraindications
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If lesions go above the sylvian fissure, a limited temporal craniotomy may not be enough to reach the lesion components above the fissure, and the craniotomy may need to be extended.
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If the lesion is in the dominant hemisphere, special consideration should be given to obtaining functional magnetic resonance imaging (MRI) or doing an awake craniotomy with speech mapping.
Planning and positioning
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Plan to give steroids and antibiotics depending on the lesion.
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Plan to give 0.5 to 1.0 g/kg of mannitol for brain relaxation if necessary.
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If the patient is to be awake during the procedure, ensure that the face is clear of any obstruction for the speech or motor mapping. Also ensure enough local anesthetic is administered at the site of pin insertion of the fixation device.
Figure 3-1:
The patient is placed in the supine position with a small roll under the ipsilateral shoulder. The head is rotated 30 to 75 degrees away from the lesion, and it can be declined 15 to 20 degrees depending on the location of the lesion. Special care should be taken to ensure that all areas of the body are properly padded to avoid skin injuries, especially if the case is long.Related posts:
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