engleski

New neurosurgical treatment options in patients with pharmacoresistant epilepsy

During the last 30 years, neurosurgical techniques of treating patients with pharmacoresistant epilepsy have changed considerably, mostly due to large progression in imaging technology, but also in physiological methods and microsurgical techniques. Best results are achieved in patients with magnetic resonance imaging (MRI) positive temporal lobe epilepsy, especially in patients with hippocampal sclerosis, and more recently in patients with extratemporal lesional epilepsy. Therefore is very important to perform careful presurgical evaluation, which should define a clear semilogy of seizures, epileptogenic lesion(s) or zone, symptomatogenic zone, irritative zone, ictal zone and zone of potential functional neurological deficit because of anatomical connections with eloquent region. Phase I and II of the presurgical evaluation are routinely being performed in the Univertsity Hospital Centre Zagreb. Besides classical resections and selective neurosurgical procedures such as selective amygdalohippocampectomy, in the last months we have performed two corpus callosotomies, which have been shown as very effective in reducing drop attacks (tonic or atonic), as was attacks connected with complex forms of polymicrogyria, tuberous sclerosis and malignant forms of primary generalized epilepsies with encephalopathies. However, we want to point out the well-known adverse effect of callosotomy connection syndrome, which can be avoided or reduced by performing partial disconnection procedure. We will also present several interesting cases of patients operated in the last year in our institution due to encephalocele located in the tip of the temporal lobe. Hamartomas, especially hypothalamic hamartomas (HHs) are rare congenital heterotopic lesions composed of neurons, glia and myelinated fibers, characterized by several peculiar symptoms, including precocious puberty, and gelastic as well as "dacrystic seizures". Based on MRI finding they can be divided into four main types. Type I and II are defined as the HHs attached to the floor of the third ventricle with narrow (Type I) or broad (Type II) interfaces. Type III ("straddling") is defined by the HH extending into the third ventricle and in terpeduncular cistern, and type IV as HH located totally within the third ventricle. The treatment of HHs has evolved considerably over the past two decades. Gamma knife surgery (GSK) is clearly the safest and the most effective approach for type I. type II and small type III HHs, while in large type III and IV HHs GSK achieves disconnection which leads to seizure reduction. We will present our experiences with GSK due to HH in one patient.

neurosurgery, pharmacoresistant epilepsy

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