title: [Epilepsy surgery--advances in presurgical evaluations and operative techniques].
abstract: In 1886, Victor Horsley realized the possibility of surgical treatment of epilepsy, which had been suggested by John H. Jackson. However, it is only recently that surgery has been widely accepted as an important method of comprehensive management of epilepsies. In general, the presurgical evaluation is carried out in two phases: first phase of noninvasive studies (EEG and videomonitoring, brain imaging, psychometrics) and second phase using surgical techniques (videomonitoring with intracranial electrodes, angiography, Wada test, functional mapping). EEG-videomonitoring to record habitual seizures of patients contributed significantly. Although in about 25% of cases, phase 1 monitoring with scalp and sphenoid electrodes may be sufficient in determining surgical indication, depth electrode exploration is still necessary in the rest of cases. Among brain imaging tests, SPECT and PET showed better correlation with EEG abnormality, PET studies in ictal stage is the most reliable methods. The classical operative techniques, such as focal resection, temporal lobectomy and callosotomy are still in use. Application of microsurgical techniques enhanced the reliability of surgical outcome. The complex partial seizures of temporal origin are the most promising candidates for surgery. Careful presurgical evaluation may warrant more than a 90% postoperative improvement.
authors.affiliation: Neurosurgery, Tokyo Met. Police Hospital.
authors.forename: Y
authors.initials: Y
authors.lastname: Mayanagi
mesh_terms: D004827:Epilepsy / Q000175:diagnosis / Q000601:surgery*; D005625:Frontal Lobe / Q000601:surgery; D006801:Humans; D008722:Methods; D011300:Preoperative Care; D013702:Temporal Lobe / Q000601:surgery