engleski

Challenges in neurosurgical treatment of epilepsy

Epilepsy is one of the most common neurological disorders and despite modern medical therapy, seizures are not adequately controlled in 25% of patients and they suffer severe morbidity, disability and social isolation. Over years, surgical treatment of epilepsy has become more sophisticated and accessible in the majority of modern countries. The objective of this review is to report on a series of patients with intractable epilepsy who underwent invasive monitoring and surgery or surgery alone when presurgical noninvasive workout showed clear surgical focus. The main challenge is whether to do a set of presurgical workout or rely on semiology and basic diagnostic procedures (electroencephalogram and 3T magnetic resonance imaging, MRI). Complex MRI positive epilepsy requires further method such as positron emission tomography (PET) and single photon emission computed tomography (SPECT) procedures, and even invasive monitoring. Through several case reports, we will discuss the decision-making process for certain patients. Presurgical workup determines the epileptic zone, the removal of which can lead to seizure freedom with an additional goal to spare the regions that mediate the key neurological functions. Modern imaging and electrophysiological methods reveal more subtle changes within the brain, and without 3T MRI with postprocessing software, PET, SPECT and invasive monitoring, tailored epilepsy surgery will never develop further. Our comprehensive team consists of dedicated neurologists, neuropsychologists, neuroradiologists and neurosurgeons. Hippocampal sclerosis is the most common cause of complex partial epilepsy of the temporal origin. Surgical resection is often the only way to gain seizure freedom in patients due to very common pharmacoresistance associated with that kind of pathology. In our series of over 100 selective amygdalohippocampectomies, seizure freedom was achieved in 85% of cases. Malformations of cortical development are a heterogeneous group of disorders characterized by abnormal cerebral cortical cytoarchitecture. Surgical excision or disconnection are the procedures which commonly end up with seizure freedom if they are not within the functional cortex. Callosotomy is very efficient in patients with drop attack, and we found it very useful when vagus nerve stimulation fails in epilepsy control. In conclusion, current types of surgical resections after invasive monitoring and extensive presurgical workout produce excellent treatment results with a high rate of seizure freedom in up to 60%-80% of cases, and a very low rate of permanent morbidity. In our series of patients, mortality rate was 0% and morbidity rate 4%.

neurosurgery ; epilepsy

nije evidentirano