Epilepsy surgery:  surgical aspects.
OBJECTIVE
This review highlights recent advances in epilepsy surgery specifically awake surgery technique, and introduces the clinical application of neuromodulation concept in this field.


RESULTS
Surgical success, improving quality-of-life in epilepsy patients, relies upon complete resection of epileptogenic areas and perfect protection of functional areas. As there is no single way to define these areas directly, invasive evaluations will be necessary in addition to conventional noninvasive ones. The optimal anesthetic management with awake surgery technique should provide favorable working conditions for the surgeons and the neurologists without compromising the safety and comfort of the patient.New methods of controlling epilepsy, based on the concept of neuromodulation, have been recently introduced. Some positive results of these new techniques, such as DBS and RNS, might lay the foundation for expansion of implantation surgery.


CONCLUSIONS
Although the final goal of epilepsy surgery is the same in most cases, -that is, maximizing normal neurological function while minimizing adverse effects, the clinical approach differs for each patient. Therefore, advancement of a new approach to identify the epileptogenic areas and new surgical treatment option would be greatly beneficial for patients with intractable epilepsy.
Department of Neurosurgery, Kyoto University Graduate School of Medicine, Kyoto, Japan. kuny@kuhp.kyoto-u.ac.jp
Takeharu
T
Kunieda
Takayuki
T
Kikuchi
Susumu
S
Miyamoto
D000758:Anesthesia / Q000379:methods; D046690:Deep Brain Stimulation; D004827:Epilepsy / Q000175:diagnosis / Q000601:surgery*; D006801:Humans; D019635:Neurosurgical Procedures / Q000379:methods*; D010166:Palliative Care; D014851:Wakefulness