Surgical Strategies (Include Cortical Resection, Lesionectomy, Cortical Stimulation and Functional Mapping, Hemispherotomy)

Surgery has a role in the treatment paradigm for patients with uncontrolled seizures. Resective surgery is reserved for patients who demonstrate drug-resistant focal seizures. Surgery performed for cortical resection is tailored to the location of the lesion. Such procedures can include a lesionectomy, anterior temporal lobectomy, tailored temporal lobe surgery with or without amygdalohippocampectomy (AHC), and selective AHC. These procedures are discussed in this chapter. Intraoperative cortical stimulation and functional mapping is utilized to direct the surgeon’s approach and guide extent of resection, particularly when lesions are within motor, sensory, language, and visuospatial areas of the brain. A meta-analysis found that the average, long-term seizure-free rates after resection, by location, was 66% for temporal lobe, 27% for frontal lobe, 46% for parietal, 46% for occipital and 16% for hemispherectomy.