You will meet with the neurosurgeon that will perform the procedure, to have your individual questions answered.
There is always a small risk of a major complication, including complications involving anesthesia, intraoperative bleeding, stroke or even death. This is true of any operation in the brain. Epilepsy surgery is a carefully planned procedure, carried out under optimal circumstances to remove the region of brain causing the seizures, and to spare parts of the brain necessary for everyday functions.
After surgery there may be swelling and even bruising around the eye on the side where the surgery was done. The eye may be puffy for up to several weeks. Some patients do not raise their eyebrow perfectly on the side of the face where the surgery was. Some have jaw pain or limited jaw movement. Headaches are common, but should not be severe. Some patients complain of a sense of fullness in the ear or earache. These problems tend to resolve in a matter of weeks or months.
The contours of the skull are usually smooth, but they may not be perfect after surgery. Surgeons make every effort to place the scar behind the hairline, when possible.
- Women: This means shaving part of your head. Your hair will grow back. There may be a quarter to half inch area on either side of the scar where your hair does not grow perfectly. The scar may also feel numb.
- Men: Over the years, your hairline may change and the scar may become more visible with less hair to cover it.
After temporal lobe surgery, some patients may have a small “blind spot” in their upper visual field, which is seldom noticeable to the patient. This is also called a visual field cut. The reason for the blind spot is that nerve fibers travel from the back of the eye to the back of the brain, passing through part of the temporal lobe. To understand the blind spot, imagine staring forward at the center of a huge clock. With the eyes fixed, it may be difficult to see details in the upper portion of the clock - for example, from around 10 to 12 o’clock or 12 to 2 o’ clock. Shifting the position of the eyes or head will change the position of the blind spot, so most people are unable to detect this on their own.
Neuropsychological testing before and after surgery shows very satisfying results. Most people experience no change in overall IQ. Patients having left-sided surgery are more likely to show a small drop in verbal memory or naming, balanced against some improvement in other test scores. Rarely, for reasons that are not well understood, a patient will experience a greater than expected decline in memory, or behavioral or emotional problems after temporal lobe surgery. The presurgical neuropsychologic and psychiatric testing and Wada tests are very important in screening for patients that might have behavioral or memory problems after surgery.
Occasionally, a patient will experience disappointment after surgery. At the UC San Diego Epilepsy Center, as well as nationally, it is recognized that epilepsy surgery is an imperfect science. Every effort is made to select only those patients who stand a very good chance of improvement, and for whom the benefits appear to outweigh the risks of surgery. We do not wish to portray epilepsy surgery as a routine procedure or “cure.” Every case is unique and is evaluated with a great deal of care and consideration – not by one physician – but by the entire epilepsy team. You should proceed with epilepsy surgery only after you have discussed the matter carefully with your physician and family, and have had all of your questions answered.