Postoperative
management of temporal lobectomy:
- OR to PACU x 1 day to floor x 1-2 day – aim for D/C on POD3
- · Early rise in body temp post op, think about incentive spirometery
- · Hep lock as soon as patient starts taking PO fluids
- · Encourage sitting and ambulating
- · Patient remains on preop AEDs for 1-2 years post op (managed by Epilepsy folks)
·
Possible
complications to look for:
o Hemiparesis
§
Usually happens after cauterization/tearing of
perforating vessels (from posterior communicating vessels or anterior choroidal
a.)
§
Paralysis usually occurs immediately – this
would be known before post op check
o Visual
field defects
§
Contralateral superior quadrant anopsia from
damage of the Meyer loop
§
Always check visual fields
o Dysphasia
§
Usually transient (1-3 weeks post op)
§
Approx 50% of dominant temp. lobe resections
have dysphasia
o Aseptic
meningitis
§
A complication that usually presents 72 hrs – 1
week post op
§
Stiff neck, severe HA, nausea, elevated body
temp
§
Diagnosis of exclusion with LP
o Post
operative seizures
§
Sz w/in 1st 24hrs does not correlate
to poor long term outcomes
§
Sz after 48hrs (with adequate AED blood levels)
indicate poor long term outcome
Source: Neurosurgical Operative Atlas 2nd Ed- Starr, Barbaro, Larson
Pic source: http://www.neuros.net/en/epilepsy_surgery.php
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