Is epilepsy surgery on both hemispheres effective?

Area of Science:

• Neurosurgery
• Epileptology
• Minimally Invasive Procedures

Background:

• Patients with bilateral independent seizure foci are often ineligible for traditional resective epilepsy surgery.
• Minimally invasive surgical techniques have been developed to address this patient population.
• This study evaluates the effectiveness of such an approach in a large patient series.

Purpose of the Study:

• To determine the effectiveness of minimally invasive surgical procedures for treating epilepsy patients with bilateral independent seizure foci.
• To assess the safety and seizure control outcomes of this approach.

Main Methods:

• A series of 61 patients underwent minimally invasive surgery with a mean follow-up of 41.5 months.
• The primary procedure was multiple subpial transection (MST), sometimes supplemented with minimal cortical resection or stereotactic amygdala-hippocampotomy.
• Preoperative evaluations included comprehensive EEG monitoring, neuroimaging, and neuropsychological assessments.

Main Results:

• 52.45% of patients achieved Engel class I seizure outcome, indicating significant seizure reduction.
• No statistical difference in outcomes was observed between the first and second halves of the series, or compared to unilateral MST series.
• No permanent neurological complications were reported, highlighting the safety of the procedure.

Conclusions:

• Minimally invasive surgery, including MST, is a safe and effective treatment for intractable epilepsy with bilateral independent foci.
• Seizure control achieved is comparable to that of unilateral hemisphere surgery.
• This approach provides a viable surgical option for patients previously considered poor candidates.