Epilepsy surgery

Area of Science:

• Neurosurgery
• Epileptology
• Neuroscience

Background:

• Epilepsy surgery is a well-established, globally increasing treatment modality.
• Recent decades show a shift towards non-invasive pre-surgical evaluations, often in collaboration with referring centers, reducing hospitalization.
• There's a growing trend for flexible, multidisciplinary approaches using modern diagnostics for patient-centered, cost-effective care.

Purpose of the Study:

• To determine the onset area of spontaneous habitual seizures.
• To differentiate the primary epileptogenic zone from the lesional zone.
• To identify necessary examinations for predicting and preventing post-operative deficits.

Main Methods:

• Non-invasive pre-surgical evaluation with increased collaboration.
• Increased use of subdural strip and grid electrode techniques over stereoelectroencephalography (SEEG).
• Utilizing functional PET and functional MRI as potential replacements for selective Amytal tests.

Main Results:

• Temporal lobe epilepsy surgery remains prevalent, with increasing use of selective amygdalohippocampectomy for mesial cases.
• Non-invasive or semi-invasive evaluations combined with MRI and PET/SPECT are standard for mesial temporal lobe epilepsy.
• Extratemporal resections without lesions are less common, but pre-surgical evaluation with grids and functional mapping is increasing for lesions.

Conclusions:

• Epilepsy surgery is evolving towards more personalized, less invasive, and multidisciplinary approaches.
• Advances in diagnostics and surgical techniques are enhancing patient care and outcomes.
• Standardized and tailored surgical interventions, including anterior callosal sections and functional hemispherectomies, are gaining prominence.