Epilepsy Surgery: Indications, Approaches, and Results

ABSTRACT

The surgical treatment of epilepsy is divided into procedures with curative or palliative goals. Curative procedures are highly effective in rendering the majority of patients seizure free, and palliative procedures often result in marked improvement in seizure frequency, quality of life, or both. This brief overview of epilepsy surgery outlines the goals of surgery, criteria used to determine patient eligibility, the various types of epilepsy surgery, and anticipated outcomes of these approaches. Newer surgical techniques including vagus nerve and deep brain stimulation and gamma knife radiosurgery are also discussed.

KEYWORD

Epilepsy surgery - temporal lobe - neocortical - disconnection - brain stimulation - radiosurgery

REFERENCES

• 1 Engel J J, Shewmon D A. Who should be considered a surgical candidate?. In: Engel JJ, ed. Surgical Treatment of the Epilepsies Vol 1. New York: Raven Press 1993: 23-34
• 2 Bourgeois B FD. The clinical challenge for new epilepsy therapies. Paper presented at: Innovative Epilepsy Therapies for the 21st Century, Merritt Putnam Symposium; 2000; Los Angeles
• 3 Kwan P, Brodie M J. Early identification of refractory epilepsy.  N Engl J Med . 2000;  342 314-319
• 4 Lhatoo S D, Wong I C, Polizzi G, Sander J W. Long-term retention rates of lamotrigine, gabapentin, and topiramate in chronic epilepsy.  Epilepsia . 2000;  41 1592-1596
• 5 Semah F, Picot M C, Adam C. Is the underlying cause of epilepsy a major prognostic factor for recurrence?.  Neurology . 1998;  51 1256-1262
• 6 Hermanns G, Noachtar S, Tuxhorn I, Holthausen H, Ebner A, Wolf P. Systematic testing of medical intractability for carbamazepine, phenytoin, and phenobarbital or primidone in monotherapy for patients considered for epilepsy surgery.  Epilepsia . 1996;  37 675-679
• 7 Wiebe S, Blume W T, Girvin J P, Eliasziw M. A randomized, controlled trial of surgery for temporal-lobe epilepsy.  N Engl J Med . 2001;  345 311-318
• 8 O'Brien T J, So E L, Mullan B P. Subtraction peri-ictal SPECT is predictive of extratemporal epilepsy surgery outcome.  Neurology . 2000;  55 1668-1677
• 9 O'Brien T J, So E L, Mullan B P. Subtraction SPECT co-registered to MRI improves postictal SPECT localization of seizure foci.  Neurology . 1999;  52 137-146
• 10 Holmes M D, Dodrill C B, Ojemann L M, Ojemann G A. Five-year outcome after epilepsy surgery in nonmonitored and monitored surgical candidates.  Epilepsia . 1996;  37 748-752
• 11 Yasargil M G, Wieser H G, Valavanis A, von Ammon K, Roth P. Surgery and results of selective amygdala-hippocampectomy in one hundred patients with nonlesional limbic epilepsy.  Neurosurg Clin North Am . 1993;  4 243-261
• 12 Roberts D W. Technical advances in the surgical treatment of epilepsy.  Adv Neurol . 2000;  84 643-649
• 13 Spencer D D, Spencer S S, Mattson R H, Williamson P D, Novelly R A. Access to the posterior medial temporal lobe structures in the surgical treatment of temporal lobe epilepsy.  Neurosurgery . 1984;  15 667-671
• 14 Wyler A R, Hermann B P, Somes G. Extent of medial temporal resection on outcome from anterior temporal lobectomy: a randomized prospective study.  Neurosurgery . 1995;  37 982-991
• 15 Zentner J, Wolf H K, Helmstaedter C. Clinical relevance of amygdala sclerosis in temporal lobe epilepsy.  J Neurosurg . 1999;  91 59-67
• 16 Miller L A, McLachlan R S, Bouwer M S, Hudson L P, Munoz D G. Amygdalar sclerosis: preoperative indicators and outcome after temporal lobectomy.  J Neurol Neurosurg Psychiatry . 1994;  57 1099-1105
• 17 Kaibara T, Myles S T, Lee M A, Sutherland G R. Optimizing epilepsy surgery with intraoperative MR imaging.  Epilepsia . 2002;  43 425-429
• 18 Schwartz T H, Marks D, Pak J. Standardization of amygdalohippocampectomy with intraoperative magnetic resonance imaging: preliminary experience.  Epilepsia . 2002;  43 430-436
• 19 Chu R M, Tummala R P, Kucharczyk J, Truwit C L, Maxwell R E. Minimally invasive procedures. Interventional MR image-guided functional neurosurgery.  Neuroimaging Clin North Am . 2001;  11 715-725
• 20 Hermann B P, Perrine K, Chelune G J. Visual confrontation naming following left anterior temporal lobectomy: a comparison of surgical approaches.  Neuropsychology . 1999;  13 3-9
• 21 Ojemann G A, Dodrill C G. Intraoperative techniques for reducing language and memory deficits with left temporal lobectomy.  Adv Epileptol . 1987;  16 327-330
• 22 Ojemann G A, Ojemann J, Lettich E. Cortical language localization in left, dominant hemisphere: an electrical stimulation mapping investigation in 117 patients.  J Neurosurg . 1989;  71 316-326
• 23 Behrens E, Schramm J, Zentner J, Konig R. Surgical and neurological complications in a series of 708 epilepsy surgery procedures.  Neurosurgery. 1997;  41 1-10
• 24 Nawrot M, Rizzo M, Rockland K S, Howard M. A transient deficit of motion perception in human.  Vision Res . 2000;  40 3435-3446
• 25 Gates J R, Rosenfeld W E, Maxwell R E, Lyons R E. Response of multiple seizure types to corpus callosum section.  Epilepsia . 1987;  28 28-34
• 26 Luessenhop A J, Dela Cruz C T, Fenichel G M. Surgical disconnection of the cerebral hemispheres for intractable seizures. Results in infancy and childhood.  JAMA . 1970;  213 1630-1636
• 27 Sass K J, Spencer D D, Spencer S S, Novelly R A, Williamson P D, Mattson R H. Corpus callosotomy for epilepsy. II. Neurologic and neuropsychological outcome.  Neurology . 1988;  38 24-28
• 28 Wilson D H, Reeves A, Gazzaniga M. Division of the corpus callosum for uncontrollable epilepsy.  Neurology . 1978;  28 649-653
• 29 Morrell F, Whisler W W, Bleck T P. Multiple subpial transection: a new approach to the surgical treatment of focal epilepsy.  J Neurosurg . 1989;  70 231-239
• 30 Spencer S S, Schramm J, Wyler A. Multiple subpial transection for intractable partial epilepsy: an international meta-analysis.  Epilepsia . 2002;  43 141-145
• 31 Orbach D, Romanelli P, Devinsky O, Doyle W. Late seizure recurrence after multiple subpial transections.  Epilepsia . 2001;  42 1130-1133
• 32 Rasmussen T. Hemispherectomy for seizures revisited. Can J Neurol Sci .  1983;  10 71-78
• 33 Schramm J, Behrens E. Functional hemispherectomy.  J Neurosurg . 1997;  87 801-802
• 34 Tinuper P, Andermann F, Villemure J G, Rasmussen T B, Quesney L F. Functional hemispherectomy for treatment of epilepsy associated with hemiplegia: rationale, indications, results, and comparison with callosotomy.  Ann Neurol . 1988;  24 27-34
• 35 Yoshioka H, Hasegawa K, Sakamoto T. Modified functional hemispherectomy in hemimegalencephaly.  Brain Dev . 1999;  21 125-128
• 36 Schramm J. Hemispherectomy techniques.  Neurosurg Clin North Am . 2002;  13 113-134
• 37 Schramm J, Kral T, Clusmann H. Transsylvian keyhole functional hemispherectomy.  Neurosurgery . 2001;  49 891-900
• 38 Edwards J C, Wyllie E, Ruggeri P M. Seizure outcome after surgery for epilepsy due to malformation of cortical development.  Neurology . 2000;  55 1110-1114
• 39 Woodbury D M, Woodbury J W. Effects of vagal stimulation on experimentally induced seizures in rats.  Epilepsia . 1990;  31 (suppl 2) S7-S19
• 40 The Vagus Nerve Stimulation Study Group. A randomized controlled trial of chronic vagus nerve stimulation for treatment of medically intractable seizures.  Neurology . 1995;  45 224-230
• 41 Amar A P, Heck C N, Levy M L. An institutional experience with cervical vagus nerve trunk stimulation for medically refractory epilepsy: rationale, technique, and outcome.  Neurosurgery . 1998;  43 1265-1280
• 42 Patwardhan R V, Stong B, Bebin E M, Mathisen J, Grabb P A. Efficacy of vagal nerve stimulation in children with medically refractory epilepsy.  Neurosurgery . 2000;  47 1353-1358
• 43 Velasco F, Velasco M, Marquez I, Velasco G. Role of the centromedian thalamic nucleus in the genesis, propagation and arrest of epileptic activity. An electrophysiological study in man.  Acta Neurochir Suppl (Wien) . 1993;  58 201-204
• 44 Kida Y, Kobayashi T, Tanaka T, Mori Y, Hasegawa T, Kondoh T. Seizure control after radiosurgery on cerebral arterio-venous malformations.  J Clin Neurosci . 2000;  7 (suppl 7) S6-S9
• 45 Kurita H, Kawamoto S, Suzuki I. Control of epilepsy associated with cerebral arteriovenous malformations after radiosurgery.  J Neurol Neurosurg Psychiatry . 1998;  65 648-655
• 46 Ghossoub M, Nataf F, Merienne L, Devaux B, Turak B, Roux F X. [Characteristics of epileptic seizures associated with cerebral arteriovenous malformations].  Neurochirurgie . 2001;  47 168-176
• 47 Heikkinen E R, Konnov B, Melnikov L. Relief of epilepsy by radiosurgery of cerebral arteriovenous malformations.  Stereotact Funct Neurosurg . 1989;  53 157-166
• 48 Regis J, Bartolomei F, Kida Y. Radiosurgery for epilepsy associated with cavernous malformation: retrospective study in 49 patients.  Neurosurgery . 2000;  47 1091-1097
• 49 Regis J, Bartolomei F, de Toffol B. Gamma knife surgery for epilepsy related to hypothalamic hamartomas.  Neurosurgery . 2000;  47 1343-1351
• 50 Chen Z F, Kamiryo T, Henson S L. Anticonvulsant effects of gamma surgery in a model of chronic spontaneous limbic epilepsy in rats.  J Neurosurg . 2001;  94 270-280
• 51 Maesawa S, Kondziolka D, Dixon C E, Balzer J, Fellows W, Lunsford L D. Subnecrotic stereotactic radiosurgery controlling epilepsy produced by kainic acid injection in rats.  J Neurosurg . 2000;  93 1033-1040
• 52 Regis J, Bartolomei F, Rey M, Hayashi M, Chauvel P, Peragut J C. Gamma knife surgery for mesial temporal lobe epilepsy.  J Neurosurg . 2000;  93 (suppl 3) 141-146
• 53 Litt B, Esteller R, Echauz J. Epileptic seizures may begin hours in advance of clinical onset: a report of five patients.  Neuron . 2001;  30 51-64
• 54 Stein A G, Eder H G, Blum D E, Drachev A, Fisher R S. An automated drug delivery system for focal epilepsy.  Epilepsy Res . 2000;  39 103-114