Principles of surgery for epilepsy.
The pre-requisite conditions for surgical treatment of epilepsy are: ineffective pharmacotherapy, the unacceptable nature of the seizures and the presence of an organic brain lesion as the basis of the disease. The principles of surgery stem from knowledge of the anatomicofunctional structure and evolution of the epileptic process, which indicate the targets for surgery. Two main groups of surgical approaches are available. The first and most efficient one aims at suppressing the seizures by acting on the nucleus of origin of the epilepsy; the combined removal of both the causative cerebral lesion and the primary epileptogenic zone is considered as the "optimal" type of surgery (hemispherectomy, lobectomy, topectomy); only in rare cases is an ablation limited either to the causative lesion (mainly in children) or to the epileptogenic zone sufficient. The second group of surgical procedures aims at reducing the cerebral epileptogenicity by preventing diffusion of the epileptic discharges (callosotomy, subpial transections), by enhancing inhibitory (cerebellar stimulation) or reducing facilitatory influences (stereotactic deep lesions); these are regarded as a "second choice" treatment. The final surgical indication, the choice of the surgical approach and the surgical prognosis are dependent on accurate presurgical investigations. The very good results which can be obtained should favour the wider use of surgery.
Rossi
G F
GF
Institute of Neurosurgery, Catholic University, Rome, Italy.
D001931:Brain Mapping; D002540:Cerebral Cortex / Q000601:surgery; D004828:Epilepsies, Partial / Q000601:surgery*; D006801:Humans; D011183:Postoperative Complications / Q000209:etiology; D011612:Psychosurgery / Q000379:methods