Surgical resection of epileptogenic cortex associated with structural lesions

In this article we have reviewed the available data for postsurgical seizure control in patients with both structural lesions and seizures. There is evidence that simple excision alone will control seizures in some patients, whereas others require, in addition, seizure surgery with resection of epileptogenic cortex. When available studies are reviewed and submitted to meta-analysis, however, we have found that more patients are seizure free at 2-year follow-up after seizure surgery than after simple excision. Seizure control is one of the many factors that influence the choice of surgical approach. Therefore, we do not recommend that all patients with structural lesions and seizures disorders undergo seizure surgery. Rather, for those patients with a structural lesion in whom seizures are medically intractable, our review supports excision of the structural lesion as well as resection of the epileptogenic cortex to provide the patient with the best opportunity of seizure control.