Abstract
Nearly 30% of epilepsy patients are refractory to medical therapy. Surgical management
of epilepsy is an increasingly viable option for these patients. Although surgery
has historically been used as a palliative option, improvements in technology and
outcomes show its potential in certain subsets of patients. This article reviews the
two main categories of surgical epilepsy treatment—resective surgery and neuromodulation.
Resective surgery includes temporal lobe resections, extratemporal resections, laser
interstitial thermal therapy, and disconnection procedures. We discuss the three main
types of neuromodulation—vagal nerve stimulation, responsive neurostimulation, and
deep brain stimulation for epilepsy. The history and indications are explored for
each type of treatment. Given the myriad types of resection and neuromodulation techniques,
patient selection is reviewed in detail, with a discussion on which patients are most
likely to benefit from different treatment strategies. We also discuss outcomes with
examples of the pertinent landmark trials and their results. Finally, complications
and surgical technique are reviewed. As new indications emerge and patient selection
is refined, surgical management will continue to evolve as an adjuvant therapy for
epileptic patients.
Keywords
epilepsy surgery - resection - neuromodulation
