Presurgical assessment and surgical treatment for epilepsy

In the last ten years, dramatic advances in surgical treatment options and techniques have allowed surgical intervention for patients who would otherwise not have been considered as surgical candidates. In this article, a multidisciplinary, logical decision algorithm for a rational approach to surgical treatments is outlined. A carefully considered hierarchy is presented that provides for maximized seizure improvement outcomes. Topics presented include temporal lobectomy, detailed discussion of dominant temporal lobectomy and speech-sparing techniques, neocortical resection, the use of subdural electrode array, depth electrodes, and strip electrodes, multiple subpinal transection, vagus nerve stimulation, and corpus callosotomy. The application of these various techniques to maximize surgical outcome are discussed.