Name of the Procedure:

Craniotomy with elevation of bone flap for temporal lobectomy, without electrocorticography during surgery.

• Commonly referred to as a temporal lobectomy or temporal lobe resection.

Summary

A craniotomy with elevation of bone flap for temporal lobectomy is a surgical procedure where a section of the temporal lobe of the brain is removed. This procedure is performed without the use of electrocorticography (ECoG), a technique that records electrical activity from the cerebral cortex.

Purpose

This procedure is primarily used to address certain conditions affecting the temporal lobe, such as epilepsy that has not responded to medication, brain tumors, and other abnormalities. The goal is to remove the problematic part of the brain to reduce or eliminate seizures or other neurological symptoms.

Indications

• Persistent epilepsy unresponsive to medication
• Temporal lobe tumors
• Arteriovenous malformations (AVMs)
• Certain inflammatory or infectious processes in the temporal lobe Patients suitable for this procedure typically have a confirmed diagnosis indicating that the area of the brain to be removed is the source of their symptoms.

Preparation

• Patients may be instructed to fast 8-12 hours before surgery.
• Adjustments in medications, particularly anti-seizure drugs, may be needed prior to the procedure.
• Diagnostic imaging such as MRI or CT scans, and other assessments may be required to map the area of the brain for surgery.

Procedure Description

1. Anesthesia: The patient is given general anesthesia to ensure they are asleep and pain-free during the surgery.
2. Incision: A craniotomy incision is made in the scalp over the temporal lobe.
3. Bone Flap: A section of the skull (bone flap) is temporarily removed to access the brain.
4. Lobectomy: The surgeon carefully removes the affected part of the temporal lobe.
5. Closure: The bone flap is replaced and secured, the scalp is sutured closed. The procedure uses precise surgical tools and imaging technology to ensure accuracy and safety.

Duration

The procedure typically takes between 3 to 5 hours, depending on the complexity.

Setting

This surgery is performed in a hospital operating room equipped with advanced neurosurgical tools.

Personnel

• Neurosurgeon
• Anesthesiologist
• Surgical nurses
• Operating room technicians
• Possibly a neuropsychologist or neurologist for intraoperative guidance

Risks and Complications

• Infection
• Bleeding or hematoma
• Stroke or brain injury
• Neurological deficits (e.g., speech or memory problems)
• Seizures
• Complications with anesthesia

Benefits

• Significant reduction or complete elimination of seizures
• Removal of brain tumors or other abnormalities
• Improved quality of life and reduction in seizure-related injuries Benefits typically start to be realized within a few weeks following recovery.

Recovery

• Hospital stay of about 3 to 7 days
• Pain managed with medications
• Follow-up appointments for monitoring and possible adjustments in medication
• Gradual return to normal activities over a few weeks to months
• Physical and occupational therapy may be recommended

Alternatives

• Medication management (antiepileptic drugs)
• Less invasive surgical options, such as laser ablation
• Vagus nerve stimulation (VNS)
• Responsive neurostimulation (RNS)
• Pros and cons of alternatives vary; generally, non-surgical options might be less effective for drug-resistant epilepsy, but also come with fewer risks.

Patient Experience

• The patient will be under general anesthesia during the procedure, so they will not feel pain or be aware of the surgery.
• Post-surgery, patients may experience pain at the incision site, headaches, and fatigue.
• Pain and discomfort are managed with prescribed medications.
• Emotional and psychological support may be needed as the patient adjusts to changes following surgery.