Postoperative management of temporal lobectomy

Postoperative management of temporal lobectomy:
  1.     OR to PACU x 1 day to floor x 1-2 day – aim for D/C on POD3
  2. ·      Early rise in body temp post op, think about incentive spirometery
  3. ·      Hep lock as soon as patient starts taking PO fluids
  4. ·      Encourage sitting and ambulating
  5. ·     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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