Temporal Lobectomy Case Study

For patients with temporal lobe epilepsy there is a high resistant to medication. This leads to a risk of memory impairments and mood disturbances. Long-term this leads to quality of life impairments and an increased risk of death. Due to the resistant to medication surgery is recommended for patients with TLE. Anteromesial temporal lobectomy (AMTL) is the most common surgery for the treatment of patients with TLE. AMTL is performed in both children and adults. AMTL is done in 30-40% of surgery resections in children, and 62-73% of resections in adults (Cossu et al, 2008). AMTL is an invasive surgery involving the temporal bone and lobe.
The skin and other layers protect the temporal muscle and bone. The skin is the most superficial layer,
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These gyri are separated by several sulci. The lateral aspect of the temporal lobe has the superior and inferior sulci which delineate superior, middle, and inferior temporal gyri. The superior surface of the temporal lobe forms the floor of the lateral sulcus. One gyri seen here is the transverse temporal gyri which makes up the primary auditory cortex. The circular sulcus surrounds the insula and is lateral to the superior surface of the temporal lobe. The insula forms the floor of the lateral sulcus. The landmarks for the temporal lobe include the Sylvian fissure which separates the temporal lobe from the frontal and parietal lobes. The fusiform gyrus is seen on the inferior surface of the brain posteriorly into the occipital lobe. The occipitotemporal sulcus separates the medial border of the inferior temporal gyrus from the lateral border to the occiptotempral gyrus. Medial to the occipitotemporal gyrus is the collateral sulcus. Medial to the collateral sulcus is the parahippocampal gyrus. The uncus is projection of the medial surface of the anterior end of the parahippocampal …show more content…
The resection line starts along the medial edge of the temporal pole and turns toward the middle temporal gyri, the line continues along the upper border of the middle temporal gyrus. The superior temporal gyrus is spared posteriorly. The line is then incised, but done carefully to avoid injury to the middle cerebral artery branches on the Sylvain fissure. Next the temporal horn is located. The temporal horn is found on the anterior end of the temporal lobe on the superior temporal sulcus. The localization of the temporal horn is done through dissecting toward the floor of the middle cranial fossa until gray matter is seen, then the dissection moves medially into the white matter until the temporal horn is entered. The dissection at this point with reflect the cerebrospinal fluid at the level of the inferior portion of the lateral ventricles. After the temporal horn is located three incisions are made to complete the lateral neocortical temporal resection. The first incision and second incision intersect at the temporal horn. *The third incision is directed to collateral fissure, and the lateral neocortex is removed. These three incisions dissects the temporal neocortex to expose the parahippocampus/hippocampus

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