61538 Craniotomy with elevation of bone flap; for lobectomy, temporal lobe, with electrocorticography during surgery

Name of the Procedure:

Craniotomy with elevation of bone flap for lobectomy, temporal lobe, with electrocorticography during surgery.

Summary

A craniotomy with elevation of bone flap for a temporal lobe lobectomy involves surgically removing part of the temporal lobe in the brain. During the procedure, the exposed brain tissue is monitored using electrocorticography to ensure precise removal and minimize damage to functional areas.

Purpose

This procedure is performed to address severe epilepsy or brain tumors localized in the temporal lobe. The goal is to remove the damaged or diseased brain tissue to reduce or eliminate seizures and improve the patient's quality of life.

Indications

• Intractable epilepsy not responsive to medication
• Temporal lobe tumors
• Structural abnormalities in the temporal lobe causing neurological issues
• Certain cases of temporal lobe encephalitis

Preparation

• Pre-surgical MRI or CT scans for planning
• Possible pre-surgical neuropsychological testing
• Fasting for 8-12 hours prior to surgery
• Adjustments to medications, particularly those affecting blood clotting

Procedure Description

1. The patient is given general anesthesia.
2. The surgeon makes an incision in the scalp and removes a section of the skull (bone flap).
3. Electrocorticography electrodes are placed on the brain's surface to map functional areas and monitor brain activity.
4. The problematic section of the temporal lobe is precisely removed.
5. The bone flap is replaced, and the scalp is closed with sutures or staples.
6. The patient is monitored in the recovery room until anesthesia wears off.

Duration

The procedure typically takes 4-6 hours.

Setting

This procedure is performed in a hospital's operating room.

Personnel

• Neurosurgeon
• Anesthesiologist
• Neurologist (optional, for electrocorticography monitoring)
• Surgical nurses
• Operating room technicians

Risks and Complications

• Infection
• Bleeding or hematoma
• Swelling of the brain
• Neurological deficits such as speech, memory, or motor function loss
• Seizures
• Reaction to anesthesia

Benefits

• Significant reduction or elimination of seizures
• Improved quality of life
• Potential removal of brain tumors

Recovery

• Initial hospital stay of several days for monitoring
• Gradual return to normal activities over 4-6 weeks
• Follow-up appointments for neuropsychological evaluation and brain scans
• Physical therapy if needed for any neurological deficits

Alternatives

• Medical management with antiepileptic drugs
• Vagal nerve stimulation or responsive neurostimulation (RNS)
• Less invasive surgical procedures such as laser ablation
• Pros of alternatives include less invasive nature; cons include potentially lower efficacy compared to lobectomy.

Patient Experience

During the procedure, the patient will be under general anesthesia and will not feel anything. Post-procedure, there may be some pain and swelling at the surgical site, managed with pain medication. The patient might experience temporary neurological deficits and will need ample rest and follow-up care.