[Surgical treatment for intractable epilepsy]

Area of Science:

• Neurosurgery
• Epileptology
• Neurology

Context:

• Intractable epilepsy in adults often necessitates surgical intervention.
• Epilepsy surgery encompasses resective (e.g., temporal lobectomy) and disconnective (e.g., multiple subpial transection - MST) techniques.
• Temporal lobe epilepsy is a prevalent form of adult intractable epilepsy.

Purpose:

• To illustrate the preoperative diagnosis and surgical outcomes of temporal lobectomy and MST.
• To review noninvasive preoperative evaluation methods for localizing seizure foci.
• To discuss the efficacy and potential sequelae of temporal lobectomy and MST.

Summary:

• Noninvasive evaluations accurately localize seizure foci in 70% of temporal lobe epilepsy cases.
• Temporal lobectomy yields satisfactory results, with 70% seizure-free and over 90% significantly improved, though verbal amnesia is a risk.
• Multiple subpial transection (MST) allows surgical treatment of eloquent cortex, achieving significant improvement in 80% of neocortical epilepsy cases, and is applicable to extensive epileptic foci, Rasmussen's encephalitis, and Landau-Kleffner syndrome.

Impact:

• Provides insights into surgical management strategies for different types of epilepsy.
• Highlights the effectiveness and limitations of specific epilepsy surgical procedures.
• Informs clinical decision-making regarding preoperative evaluation and surgical selection for intractable epilepsy.