Surgical Treatment of Epilepsy
- Indications
for Surgery
- Medically
intractable seizures
- Must
undergo comprehensive drug trial
- However,
most often patients are not referred early enough rather than too early
- Surgical
Procedures
- Invasive
Monitoring
- Used primarily
to determine site of resection and/or laterality of seizure onset
- Subdural
strips and grids
- Depth
electrodes
- Foramen
ovale electrodes
- Anterior
Temporal Lobectomy
- Most
common surgical procedure for epilepsy
- Usually
performed for mesial temporal sclerosis (MTS, sometimes visible on
coronal MRI)
- Resection
of anterior temporal lobe for temporal lobe epilepsy (most common type)
- Classically
remove 3 cm (dominant side) or 4.5 cm (non-dominant side) of temporal
neocortex, along with amygdala and pes hippocampus
- Can
remove amygdala/hippocampus via frameless stereotaxy for minimally
invasive approach
- Requires
preoperative seizure monitoring, neuropsychological testing, and Wada
test
- Vagal
Nerve Stimulation
- Used
for seizures of bilateral or generalized origin without structural
abnormality for resection
- Left
vagus nerve used (right side controls heart SA node)
- Leads
wrapped around nerve, tunneled to generator in chest wall
- Affects
cerebral blood flow and neurotransmission
- Also
used for depression
- Corpus
Callosotomy
- Prevent
generalization of seizures
- Usually
section anterior part only
- Hemispherectomy
- Anatomic:
removal of entire hemisphere to basal ganglia (only for severely damaged
brain with no useful function)
- Functional:
temporal lobectomy + corpus callosotomy
- Lesionectomy
- Removal
of cavernoma or tumor
- Removal
of cortical dysplasia