Patient expectations of temporal lobe surgery

Abstract

Purpose: The purpose of this study was to examine expectations of postoperative quality of life expressed by patients undergoing anterior temporal lobectomy (ATL) for the control of intractable seizures. An important component of this study was an exploration of the relationship between preoperative expectations and perceived success of the operation.

Methods: Psychosocial functioning of 60 patients was assessed pre- and postoperatively, using a standardised, semistructured clinical interview. Preoperative assessment included a detailed examination of the patients' expectations of surgery, while postoperative assessment at 6 months examined the patients' perception of surgical success with respect to seizure outcome and postoperative psychosocial status.

Results: A range of expectations were expressed about postoperative outcome. These were classified into 11 posthoc categories. Patients who perceived the operation as a success tended to endorse 'practical' expectations (i.e., driving, employment, activities) preoperatively, rather than expectations of a psychologic or social nature (i.e., self-change, relationships). These patients experienced fewer postoperative seizures and psychosocial difficulties. In contrast, a perceived lack of success was associated with greater emphasis on psychosocial expectations preoperatively. These patients experienced a greater number of perceived postoperative psychosocial difficulties, and more postoperative seizures.

Conclusions: Preoperative expectations of surgery formed an important baseline against which to assess postoperative outcome, and should constitute a routine part of assessment in studies of psychosocial outcome of ATL.