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Incidental aneurysms in temporal lobe epilepsy surgery: report of three cases and a review of the literature.

Publication ,  Journal Article
Lad, SP; Shannon, L; Byrne, RW
Published in: Br J Neurosurg
February 2012

OBJECTIVE AND IMPORTANCE: In rare instances, patients who are undergoing evaluation for temporal lobe epilepsy surgery will also be found to have an incidental aneurysm adjacent to the temporal lobe. Although busy epilepsy centers will eventually come across cases like this, to our knowledge there are currently no publications regarding such cases or the complex management decisions that follow in caring for these patients. Factors affecting decision making in these cases are discussed in detail. CLINICAL PRESENTATION: Three cases where an incidental aneurysm was discovered during the evaluation and treatment of temporal lobe epilepsy are discussed. Two cases of middle cerebral artery (MCA) aneurysm, one ipsilateral to the planned temporal lobectomy and one contralateral aneurysm unsuitable for coiling, were discovered preoperatively. In one case, an incidental posterior cerebral artery (PCA) aneurysm was noted during an amygdalohippocampectomy. Intervention. In the ipsilateral MCA aneurysm case, the aneurysm was clipped during the temporal lobectomy. In the case of a contralateral MCA aneurysm, the aneurysm was electively clipped prior to the temporal lobectomy. In the PCA aneurysm case, the aneurysm was clipped at the time of discovery during surgery. CONCLUSION: Incidentally noted unruptured aneurysms in patients undergoing evaluation and treatment of medically intractable epilepsy add a level of complexity to medical decision making in these cases. Factors affecting treatment decisions include the size and location of the aneurysm, risks of aneurysm treatment, patient age, severity of the epilepsy condition and patient wishes after discussion of treatment options.

Duke Scholars

Published In

Br J Neurosurg

DOI

EISSN

1360-046X

Publication Date

February 2012

Volume

26

Issue

1

Start / End Page

69 / 74

Location

England

Related Subject Headings

  • Risk Factors
  • Neurology & Neurosurgery
  • Male
  • Intracranial Aneurysm
  • Incidental Findings
  • Humans
  • Female
  • Epilepsy, Temporal Lobe
  • Aneurysm, Ruptured
  • Adult
 

Citation

APA
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ICMJE
MLA
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Lad, S. P., Shannon, L., & Byrne, R. W. (2012). Incidental aneurysms in temporal lobe epilepsy surgery: report of three cases and a review of the literature. Br J Neurosurg, 26(1), 69–74. https://doi.org/10.3109/02688697.2011.601819
Lad, Shivanand P., Larry Shannon, and Richard W. Byrne. “Incidental aneurysms in temporal lobe epilepsy surgery: report of three cases and a review of the literature.Br J Neurosurg 26, no. 1 (February 2012): 69–74. https://doi.org/10.3109/02688697.2011.601819.
Lad, Shivanand P., et al. “Incidental aneurysms in temporal lobe epilepsy surgery: report of three cases and a review of the literature.Br J Neurosurg, vol. 26, no. 1, Feb. 2012, pp. 69–74. Pubmed, doi:10.3109/02688697.2011.601819.

Published In

Br J Neurosurg

DOI

EISSN

1360-046X

Publication Date

February 2012

Volume

26

Issue

1

Start / End Page

69 / 74

Location

England

Related Subject Headings

  • Risk Factors
  • Neurology & Neurosurgery
  • Male
  • Intracranial Aneurysm
  • Incidental Findings
  • Humans
  • Female
  • Epilepsy, Temporal Lobe
  • Aneurysm, Ruptured
  • Adult