title: [Patients with intractable epilepsy who achieved good seizure control after craniotomy instead of vagal nerve stimulation].
abstract: Vagal nerve stimulation(VNS)is an effective adjunctive therapy for medically intractable epilepsy. However, VNS is a palliative therapy, and craniotomy should preferably be performed when complete seizure remission can be expected after craniotomy. We report here three patients who were referred for VNS therapy, but underwent craniotomy instead of VNS based on the results of a comprehensive preoperative evaluation, and achieved good seizure control. Case 1 was a 48-year-old woman with left temporal lobe epilepsy and amygdalar enlargement. Even though no left hippocampal sclerosis was observed on magnetic resonance imaging, she underwent left anterior temporal lobectomy and hippocampectomy. Case 2 was a 36-year-old woman with multiple bilateral subependymal nodular heterotopias, who underwent resection of the left medial temporal lobe including subependymal nodular heterotopias adjacent to the left inferior horn. Case 3 was a 25-year-old man with posttraumatic epilepsy. As the right hemisphere was most affected, multiple subpial transections were performed on the left frontal convexity. These three patients were referred to us for VNS therapy because there was a dissociation between the interictal electroencephalogram and magnetic resonance imaging findings, or because they had multiple or extensive epileptogenic lesions. Comprehensive preoperative evaluation including ictal electroencephalography can help to identify patients who are suitable candidates for craniotomy.
authors.affiliation: Department of Neurosurgery, Kyushu Rosai Hospital.
authors.forename: Takato
authors.initials: T
authors.lastname: Morioka
authors.forename: Takashi
authors.initials: T
authors.lastname: Shimogawa
authors.forename: Tetsuro
authors.initials: T
authors.lastname: Sayama
authors.forename: Kimiaki
authors.initials: K
authors.lastname: Hashiguchi
authors.forename: Nobuya
authors.initials: N
authors.lastname: Murakami
authors.forename: Hiroshi
authors.initials: H
authors.lastname: Shigeto
authors.forename: Satoshi O
authors.initials: SO
authors.lastname: Suzuki
authors.forename: Ayumi
authors.initials: A
authors.lastname: Sakata
authors.forename: Kosuke
authors.initials: K
authors.lastname: Makihara
authors.forename: Koji
authors.initials: K
authors.lastname: Iihara
mesh_terms: D038481:Anterior Temporal Lobectomy / Q000379:methods; D003399:Craniotomy; D004569:Electroencephalography / Q000379:methods; D004827:Epilepsy / Q000503:physiopathology / Q000601:surgery*; D005260:Female; D006801:Humans; D008279:Magnetic Resonance Imaging / Q000379:methods; D008875:Middle Aged; D016896:Treatment Outcome; D055536:Vagus Nerve Stimulation / Q000379:methods