Extratemporal Cortical Resection

1 What is an Extratemporal Cortical Resection?

Read on to learn more about extratemporal cortical resection procedure.

Epilepsy is a set of chronic neurological disorders characterized by seizures and the diagnosis of epilepsy implies that there is an abnormality in the brain and that this abnormality will result in more epileptic seizures.

Seizures can start in any portion of the cerebral cortex – the outer layer (gray matter) of the cerebrum, but the most seizures in teens and adult start at the temporal lobe of the brain.

By extratemporal cortical resection, brain tissue that contains a seizure focus is being resected or cut away area of the brain located other than the temporal lobe, mostly the frontal lobe.

The good candidate for a procedure is a patient with epilepsy whose seizures are disabling and/or not controlled by medications, or when the side effects of the medication are severe and significantly affect the person's quality of life.

Before the procedure, a candidate must undergo an extensive pre-surgery evaluation including video electroencephalographic (EEG) seizure monitoring, magnetic resonance imaging (MRI), and positron-emission tomography (PET).

Also, other tests including neuropsychological memory testing, WADA test (to lateralize the side of language), ictal SPECT, and magnetic resonance spectroscopy can be performed to pinpoint the seizure focus and determine if surgery is possible.

During the procedure, the patient is put to sleep (general anesthesia) and the surgeon makes an incision in the scalp, removes a piece of bone and pulls back a section of the tough membrane that covers the brain (dura).

The area is being magnified with a surgical microscope. Sometimes, the patient must be awake with the use of medication to keep person relaxed and pain-free so the patient can help the surgeon find and avoid areas in the brain responsible for vital functions such as movement, sensation, language and memory.

At the end of the procedure, after the brain tissue is removed, the dura and bone are fixed back into place, and the scalp is closed using stitches or staples.

After the procedure, the patient usually stays in the hospital for two to four days and he/she can return to normal activities, including work or school four to six weeks after surgery. Most patients will need to continue taking anti-seizure drugs for two or more years after surgery and when the seizure control is established, medications can be reduced or eliminated.

Extratemporal cortical resection is effective in eliminating or dramatically reducing seizures in 45% to 65% of cases and it is more effective if only one area of the brain is involved.

Side effects of extratemporal cortical resection are:

  • Headaches
  • Scalp numbness
  • Nausea
  • Feeling tired or depressed and difficulty speaking
  • Remembering things or finding words but they generally go away on their own

The complications are rare and depend on which area of the brain is involved but they can include:

  • Swelling of the brain
  • Failure to relieve seizures
  • Risks associated with surgery
  • Including infection
  • Bleeding
  • Allergic reaction to anesthesia
  • Changes in personality or behavior
  • Partial loss of vision, memory, or speech
  • Stroke