Epilepsy Program

Temporal Lobectomy Surgical Procedure

After the patient is positioned and asleep, the surgery begins. A patch of hair over the temple is shaved, but it is not necessary to shave the entire head.  Skin is cut in a "C"-shaped partial circle above the ear.  Several nickel-sized holes are drilled in a circular pattern. A bone-saw cuts between the holes to remove a circle of bone about the circumference of a small coffee cup rim. At the end of the procedure, this bone will be hard-wired back in place and eventually will calcify to seal to the skull.  The wires are non-magnetic (MRI compatible), hold the bone firmly in place, and never need to be removed.

The membrane over the brain, the dura mater, then is cut open, exposing the temporal lobe.  Portions of the temporal lobe are removed by suction, since the brain has a "firm pudding" consistency. Different surgeons use different techniques and approaches, depending upon preference and training, but no one technique is proven superior to the others. The amount usually removed ranges between the size of a golf ball and a small lemon, representing well less than half the volume of the temporal lobe.

The portion of brain removed never grows back. The space that it occupied fills with the fluid surrounding the brain. Patients sometimes wonder why replacing a seizure-producing scar with a surgical scar is beneficial. The reason is that not all scars are alike.  The "clean" scar left by neurosurgery rarely leads to seizures.  Closure of the surgical field occurs in reverse order to the opening.

Patients typically are in the operating room and recovery room for 4 - 8 hours, sometimes longer.  Most delays in returning from surgery are administrative problems in getting the operation started, so family should not assume that that the surgery is the cause of the long wait.  The operation itself usually takes about 2 - 3 hours.

The family should be prepared for the patient to be disoriented for a day postoperatively.  Headache is a clear issue, but over-medication is avoided to allow the patient to wake up. The patient will be nauseated from the anesthesia, have a sore throat from the breathing tube, and will have swelling and bruising of the forehead and eye on the side of surgery.  The swelling increases to a peak 2 - 4 days after surgery. An overnight or two-day stay in intensive care is common. 

By day three after surgery, most patients are able to sit in a chair, walk with assistance, and eat.  Until post-operative patients can eat and drink, seizure medications are given intravenously.  Since not every medicine has an intravenous form, a temporary switch to one that does may be required. Hospital discharge happens 3 - 7 days after surgery.  Patients should plan on staying at home with assistance for a week, and staying off work or heavy activities for a month.  A few patients have persistent headache or fatigue, and require 2 - 3 months post-operative rest.

Complications of Temporal Lobectomy

Complications occur in about two percent of patients (one-in-fifty) who have this surgery.  Complications can be serious, including as a partial list:

  • Severe speech problems
  • Reading difficulties
  • Stroke, partial paralysis or numbness
  • Personality change
  • Deterioration of memory ability
  • Partial loss of vision
  • Psychiatric deterioration
  • Severe depression
  • Psychosis
  • Death (0.1 - 0.5%)
  • Others 

Less serious complications occur more often, such as deterioration of word-finding ability for a few months after surgery, (pain-itching around the skin scar (especially as it heals), infection of the surgical site, skull indentations or other cosmetic defects, persistent headaches, minor loss of upper peripheral vision on the side opposite the surgery, drooping of eyelid or forehead on the surgical side, transient depression, and a variety of other problems. 

Seizures occasionally flare up for 1 - 2 months after seizure surgery, as the brain heals.  Seizures during the postoperative months do not mean that the operation was a failure, seizures may settle down with healing. You should discuss the potential benefits and risks of surgery with your surgeon, and give what is known as "informed consent" for the procedure if you agreed to have surgery.

Epilepsy surgery is successful about 75 percent of the time.  Patients may be able to go off all medications, typically about a year after the surgery.  Some patients choose to stay on their medications; others become free from seizures, but still require medication.  Benefit of surgery may fall short of a complete cure.  Patients may still have occasional auras (simple partial warnings) or rare breakthrough seizures at times of great stress.  Twenty-five percent of patients do not respond favorably to seizure surgery, usually because not all of the focus could be removed or because the seizures were in fact multi-focal.


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