Cerebral vasospasm after temporal lobe epilepsy surgery: clinically important?

Commentary Cerebral vasospasm (CVS) is well known to be clinically significant after subarachnoid hemorrhage and has been thoroughly studied in that setting. There has been limited study of CVS following cranial surgeries for tumors, vascular lesions and epilepsy. The incidence of transcranial Doppler sonography (TCD)-defined CVS after certain cranial surgeries has been documented in several studies, but its clinical significance has not been well characterized. There is reason to suspect that the incidence of CVS may vary among surgeries for various pathologies and among various surgical approaches and techniques for similar pathologies. It is important to gain a better understanding of the causes of post-operative CVS and understand its clinical significance. The current study provides a large experience at a single center, documenting the occurrence of TCD-defined CVS following two different methods of temporal lobe resection for medically intractable temporal lobe epilepsy and the correlation of this CVS with neurologic morbidity. The two different methods of temporal lobe resection were selective amygdalohip-pocampectomy (AHE) using the transsylvian fissure technique developed by Yasargil (1) and the anterior temporal lobe (TLR) resection technique used by Falconer (2). This well-conducted study succeeds in demonstrating that TCD-defined CVS has a relatively high incidence following temporal lobe surgery, revealing some of the factors that may be causative. The study does not address the clinical significance of this TCD-defined CVS, but does demonstrate that it is associated with a higher incidence of postoperative neurologic signs and symptoms. This association certainly suggests that factors causing some of the postoperative neurologic morbidity may also cause the occurrence of TCD-defined CVS. However, it is important to note that postoperative neurologic morbidity typically is apparent immediately after surgery and that TCD-defined CVS is delayed in its onset. This study does not provide evidence of neurologic morbidity being associated with the time course of the TCD-defined CVS. Future studies will be needed to reveal the clinical significance of this TCD-defined CVS. The current study identified several statistically significant findings. Female gender was associated with a significantly increased incidence of TCD-defined CVS. A higher volume of blood measured in the surgical resection bed on the CT scan done on postoperative day one was also associated with an increased incidence of TCD-defined CVS. The presence of OBJECTIVE: Selective amygdalohippocampectomy (AHE) has been associated with postoperative cerebral vaso-spasm (CVS) in patients with medically intractable temporal lobe epilepsy. The incidence in temporal lobe resection (TLR) is …