Surgical treatment for epilepsy

Surgical procedures to treat severe epilepsies have gained wide distribution and general acceptance. Different approaches reflect not only different pathologies and pathophysiologies, but also the history of epileptological and surgical concepts. In temporal procedures, no homogenous data are available indicating that preservation of lateral neocortical structures is advantageous with respect to neurocognitive functions, nor that in temporomesial epilepsies lateral or extended hippocampal resection may be necessary for seizure control. Extratemporal procedures usually require extensive presurgical diagnostics, but can be successfully performed using modern techniques, including functional imaging, tractography, neuronavigation as well as intraoperative mapping and monitoring. Hemispherectomy/hemispherotomy constitutes an excellent therapeutic option for patients suffering from disastrous epilepsy with unilateral epileptogenesis. Amongst functional methods, stimulation techniques have recently gained increasing interest, while callosotomy has maintained its certain importance in the treatment of severe drop attacks. Multiple subpial transsections are almost exclusively used in addition to resection. Overall, epilepsy surgery has proven to be successful. Classic resective procedures still continue to be performed most frequently. However, during the last two decades a clear trend toward the treatment of children and adolescents has been observed.