Expanding cyst following temporal lobectomy: an unusual complication of epilepsy surgery

Following anterior temporal lobectomy performed to control intractable comp lex partial seizures (CPS), it is rare to find a symptomatic cyst at the lo bectomy site causing increased intracranial pressure and neurological deter ioration. We report a 24-year-old lady who underwent anterior temporal lobe ctomy with extended amygdalohippocampectomy for CPS of temporal lobe origin . Ten months following the procedure, she developed a large expanding cyst at the temporal lobectomy site manifesting with recurrence of CPS, progress ive focal neurological deficit and increased intracranial pressure. The pat ient underwent a repeat craniotomy, decompression of the cyst along with wi de excision of the wall and fenestration of the arachnoid membrane into the basal cisterns. Following the procedure, the features of increased intracr anial pressure and focal neurological deficit promptly improved and her sei zures became better controlled. Craniotomy and fenestration of a symptomati c iatrogenic cyst following temporal lobectomy results in clinical improvem ent, obviating the need for a permanent cystoperitoneal shunt. (C) 1999 Els evier Science B.V. All rights reserved.