TY - JOUR
T1 - Prospective analysis of diplopia after anterior temporal lobectomy for mesial temporal lobe sclerosis
AU - Cohen-Gadol, Aaron A.
AU - Leavitt, Jacqueline A.
AU - Lynch, James J.
AU - Marsh, W. Richard
AU - Cascino, Gregory D.
PY - 2003/9/1
Y1 - 2003/9/1
N2 - Object. In this prospective study the authors investigated the incidence and natural history of postoperative diplopia in patients undergoing anterior temporal lobectomy (ATL) and amygdalohippocampectomy for medically intractable mesial temporal lobe epilepsy. Methods. Forty-seven patients scheduled for ATL for medically refractory seizures were examined preoperatively, 2 to 7 days postoperatively, and 3 to 6 months postoperatively. Ophthalmological examination including pupillary measurements, stereoacuity measurements, palpebral fissure measurements, vertical fusional amplitudes, Lancaster red green testing, visual field testing, and alternate cover testing was performed. Antiepileptic drug levels were monitored. Nine (19%) of 47 patients developed diplopia postoperatively. The diplopia was caused by trochlear nerve palsy in every case. No oculomotor nerve dysfunction was documented. Trochlear nerve function recovered completely in all patients within 3 to 6 months postoperatively. Conclusions. Postoperative diplopia following ATL occurs more often than previously thought and is primarily due to trochlear nerve dysfunction. Awareness of this transient complication is important in preoperative patient counseling.
AB - Object. In this prospective study the authors investigated the incidence and natural history of postoperative diplopia in patients undergoing anterior temporal lobectomy (ATL) and amygdalohippocampectomy for medically intractable mesial temporal lobe epilepsy. Methods. Forty-seven patients scheduled for ATL for medically refractory seizures were examined preoperatively, 2 to 7 days postoperatively, and 3 to 6 months postoperatively. Ophthalmological examination including pupillary measurements, stereoacuity measurements, palpebral fissure measurements, vertical fusional amplitudes, Lancaster red green testing, visual field testing, and alternate cover testing was performed. Antiepileptic drug levels were monitored. Nine (19%) of 47 patients developed diplopia postoperatively. The diplopia was caused by trochlear nerve palsy in every case. No oculomotor nerve dysfunction was documented. Trochlear nerve function recovered completely in all patients within 3 to 6 months postoperatively. Conclusions. Postoperative diplopia following ATL occurs more often than previously thought and is primarily due to trochlear nerve dysfunction. Awareness of this transient complication is important in preoperative patient counseling.
KW - Anterior temporal lobectomy
KW - Complication
KW - Epilepsy
KW - Palsy
KW - Trochlear nerve
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U2 - 10.3171/jns.2003.99.3.0496
DO - 10.3171/jns.2003.99.3.0496
M3 - Article
C2 - 12959436
AN - SCOPUS:0041920853
SN - 0022-3085
VL - 99
SP - 496
EP - 499
JO - Journal of neurosurgery
JF - Journal of neurosurgery
IS - 3
ER -