The explanation of risks and potential complications of surgery should be part of any neurosurgical preoperative consultation. Included in this discussion should be the risk of surgical mortality, and permanent or temporary language and motor or psychologic deficits. In patients with tumor-associated epilepsy, the possibility of no improvement or worsening in seizure activity must be discussed.

Other general postoperative risks to be discussed include:

  • wound infection
  • hemorrhage
  • hydrocephalus
  • meningitis
  • deep venous thrombosis
  • pulmonary embolus
  • pneumonia

Figures specifically covering morbidity and mortality of tumor-associated epilepsy surgery are not available, but studies of epilepsy surgery by type of procedure have reported that the anterior temporal lobectomy for epilepsy carries a 0.0–0.7% mortality.179–181 Extratemporal lobectomies have 0–9% mortality. Permanent hemiparesis has been reported in between 1% and 2% of cases.

In a series of 429 patients, wound infection was the most common surgical complication, occurring in 3.5% of cases. Neurologic morbidity was reported in 5.4%, with 3.03% occurring transiently and 2.33% occurring permanently.181 These risks must be weighed against the benefits of better quality of life with relief of seizures. About 60–80% become seizure-free and another 10% or more have a significant improvement (>90% relief) in seizure activity.

Adapted from: Mangano FT, McBride AE, and Schneider SJ. Brain tumors and epilepsy. In: Ettinger AB and Devinsky O, eds. Managing epilepsy and co-existing disorders. Boston: Butterworth-Heinemann; 2002;175–194.
With permission from Elsevier (www.elsevier.com). 

Authored By: 
Steven C. Schachter, MD
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