[Surgical treatment for intractable epilepsy: update and future]

Area of Science:

• Neurosurgery
• Epileptology
• Neurophysiology

Context:

• Intractable epilepsy requires precise localization of the epileptogenic zone and functional cortex for successful surgical intervention.
• Non-invasive methods (MRI, EEG, MEG, PET) aid diagnosis but lack precision in pinpointing the exact seizure origin and critical brain areas.
• Intracranial electrodes, including subdural and depth electrodes, are essential tools for accurate presurgical mapping.

Purpose:

• To evaluate the efficacy of intracranial electrode placement for identifying epileptogenic zones and functional cortices in patients with intractable epilepsy.
• To assess the surgical outcomes of epilepsy surgery guided by intracranial electrode recordings.

Summary:

• The study involved 18 patients with temporal lobe epilepsy undergoing anterior temporal lobectomy with hippocampectomy and 10 patients with extratemporal lobe epilepsy undergoing cortical resection.
• Chronic subdural electrodes were utilized for recording and precise localization of the epileptogenic cortex.
• Multiple subpial transection was employed when the epileptogenic cortex overlapped with functional areas, achieving favorable postoperative seizure control in most cases.

Impact:

• This study highlights the critical role of intracranial electrode recordings in achieving successful surgical outcomes for intractable epilepsy.
• It underscores the limitations of non-invasive techniques in precisely defining the surgical target for epilepsy treatment.
• The findings support the use of invasive monitoring for optimizing surgical planning and improving seizure control in epilepsy patients.