The most common type of surgery for patients with temporal lobe epilepsy is a temporal lobectomy, also known as anterior temporal lobectomy (ATL). The amygdala and hippocampus, as well as a portion of the front temporal lobe, are removed. Around 70% to 80% of the time, a temporal lobectomy results in a considerable reduction or total seizure control. However, if this treatment is conducted on the dominant hemisphere, memory and language may be harmed.
Damage to the brain, bleeding (which may necessitate re-operation), blood loss (which may require transfusion), and infection are all dangers associated with open surgical procedures like ATL. Open operations also necessitate several days of hospitalization, including at least one night in an intensive care unit.
Even though such treatment is costly, several studies have shown that ATL has lower mortality, morbidity, and long-term cost in patients who have failed at least two anticonvulsant medication trials than continuing medical therapy without surgical intervention.
A prospective, randomized ATL to best medical therapy for medically resistant temporal lobe epilepsy conclusively established that the seizure-free rate after surgery was 60%, compared to only 8% for the medicine-only group.
Furthermore, the surgery group had no death, whereas the medicinal therapy group had seizure-related mortality. As a result, for patients with medically intractable mesial temporal lobe epilepsy, ATL is considered the gold standard of therapy.