Anterior temporal lobectomy.
Anterior temporal lobectomy is the most used surgical method and is the most effective procedure for seizure control. If positioned accurately, seizures can be completely stopped in more than 80% of patients after surgery and rarely cause neurological impairment.
Selective hippocampal amygdala resection for temporal lobe epilepsy can better preserve temporal lobe function.
Corpus callosotomy.
Corpus callosotomy severs all connections in the anterior part of the corpus callosum, anterior union, central block, and hippocampal union, and it is effective in preventing generalized seizures.
It is used in cases where drug therapy is ineffective and the epileptogenic focus is too extensive or located in important functional areas or multiple epileptogenic foci cannot be removed, and the EEG during the seizure phase shows partial seizures with rapid waves to the whole brain (so-called secondary bilateral synchronization).
Extratemporal lobe epileptic foci resection.
The localization and surgery of extratemporal lobe epileptic foci are much more difficult than in temporal lobe epilepsy. On the one hand, complete resection or even extended resection of the epileptic foci is required, and on the other hand, extratemporal lobe epileptic foci often involve the functional cortex.
Functional hemispherectomy technique.
This procedure removes only the temporal and central regions and cuts off the frontal and parieto-occipital lobes from the residual brain, greatly reducing postoperative complications.
Indications for hemispherectomy are: infantile hemiplegia with epilepsy, Rasmussen’s encephalitis, etc.
Subcortical transverse meningotomy.
Surgically severing the subcortical transverse fiber connections while preserving their longitudinal fiber connections is commonly used when the epileptic focus is located in a functional area such as the motor cortex or phonological area, which can avoid producing significant functional impairment.
Vagus nerve stimulation versus deep brain electrical stimulation.
Vagus nerve stimulation consists of an electrical spike generator that generates a continuous low-frequency electrical pulse that stimulates the left cervical vagus nerve for the purpose of controlling epilepsy.
Deep brain electrical stimulation involves inserting bilateral deep electrodes into certain brain nuclei, such as the STN and CM nuclei, and using low-frequency, chronic electrical stimulation to achieve seizure control.
Radiosurgery.
Radiosurgery (x-ray knife, r-knife) is used clinically to treat some people with intractable epilepsy.