Temporopolar bridging veins during anteromedial temporal strip placement: a case report on complication avoidance^†

Surgery for temporal lobe epilepsy is proven to be beneficial in the treatment of medically refractory temporal lobe epilepsy. Subdural electrode strips are commonly passed in a blind fashion, allowing additional EEG coverage without requiring larger exposure. However, this increases risk of complication, specifically through vascular injury.

We present a case of a 22-year-old male with medically refractory epilepsy. During passage of an anterior medial temporal strip electrode, resistance was encountered despite multiple attempts and redirection. This strip was abandoned. During the subsequent resection operation, a large temporopolar bridging vein complex was noted and photographed precisely where we encountered resistance.

Although much frequently less encountered than paramedian subdural strips, anterior medial temporal strip subdural electrodes may indeed injure large bridging veins. As subdural strips are passed where bony exposure is minimal, potential disastrous complications may arise if extreme caution is not used.