title: Surgical Resection for Epilepsy Following Cerebral Gunshot Wounds.
abstract: OBJECTIVE
  The surgical management of epilepsy after penetrating gunshot wounds (GSWs) to the head has not been described in the modern era. Given the extensive damage to the cranium and cortex from such injuries, the safety and efficacy of surgical intervention are unclear. We report surgical strategy and outcomes after resection for medically refractory epilepsy following GSWs in 4 patients.
  
  
  METHODS
  A prospectively compiled database of 325 patients with epilepsy was used to identify patients undergoing surgery for medically refractory epilepsy after a GSW to the brain. Seizure frequency, scalp and intracranial electroencephalography evaluation, type of resection, and seizure outcomes were compiled.
  
  
  RESULTS
  All 4 patients underwent direct electrocorticography recordings either with implanted electrodes or intraoperatively that were used to drive surgical decision making. All patients had intracranial shrapnel fragments and large areas of encephalomalacia on imaging. Intracranial electrodes were placed in 2 patients to localize seizure onsets. Two patients underwent frontal lobe resections, and the other 2 patients underwent multilobar resections. Latency between injury and epilepsy surgery was 12 years, and mean age at surgery was 28 years. In all cases, epilepsy surgery led to a significant improvement in seizure control (Engel class I, 2 patients; II, 1 patient; and III, 1 patient).
  
  
  CONCLUSIONS
  Epilepsy is common after penetrating head injury, and the incidence is likely to increase given the growing numbers of armed conflicts in urban centers worldwide. In selected cases, intracranial monitoring and surgical resections may be safely performed and can lead to favorable seizure outcomes.
authors.affiliation: Vivian L Smith Department of Neurosurgery, John P. and Kathrine G. McGovern Medical School, University of Texas Health Science Center at Houston, Houston, Texas, USA; Mischer Neuroscience Institute, Memorial Hermann Hospital - Texas Medical Center, Houston, Texas, USA.
authors.forename: Yoshua
authors.initials: Y
authors.lastname: Esquenazi
authors.affiliation: Department of Neurology, John P. and Kathrine G. McGovern Medical School, University of Texas Health Science Center at Houston, Houston, Texas, USA.
authors.forename: Giridhar P
authors.initials: GP
authors.lastname: Kalamangalam
authors.affiliation: Department of Neurology, John P. and Kathrine G. McGovern Medical School, University of Texas Health Science Center at Houston, Houston, Texas, USA.
authors.forename: Omotola A
authors.initials: OA
authors.lastname: Hope
authors.affiliation: Department of Neurology, John P. and Kathrine G. McGovern Medical School, University of Texas Health Science Center at Houston, Houston, Texas, USA.
authors.forename: Sonia N
authors.initials: SN
authors.lastname: Krish
authors.affiliation: Department of Neurology, John P. and Kathrine G. McGovern Medical School, University of Texas Health Science Center at Houston, Houston, Texas, USA.
authors.forename: Jeremy
authors.initials: J
authors.lastname: Slater
authors.affiliation: Vivian L Smith Department of Neurosurgery, John P. and Kathrine G. McGovern Medical School, University of Texas Health Science Center at Houston, Houston, Texas, USA; Mischer Neuroscience Institute, Memorial Hermann Hospital - Texas Medical Center, Houston, Texas, USA. Electronic address: Nitin.tandon@uth.tmc.edu.
authors.forename: Nitin
authors.initials: N
authors.lastname: Tandon
mesh_terms: D000328:Adult; D001930:Brain Injuries / Q000000981:diagnostic imaging / Q000209:etiology / Q000601:surgery*; D002540:Cerebral Cortex / Q000000981:diagnostic imaging / Q000601:surgery*; D016208:Databases, Factual; D004827:Epilepsy / Q000209:etiology / Q000601:surgery*; D005260:Female; D006801:Humans; D008297:Male; D011446:Prospective Studies; D014948:Wounds, Gunshot / Q000150:complications / Q000601:surgery*; D055815:Young Adult
keywords: Encephalomalacia; Frontal lobectomy; Intractable epilepsy; Posttraumatic epilepsy; Resective surgery for epilepsy