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

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.