What is the principle of epilepsy surgical treatment?
Epilepsy surgery is generally performed to cure epilepsy by direct removal of the epileptogenic lesion. However, for those whose epileptic foci are located in functional brain areas or inaccurate localization, seizures can be controlled by blocking the propagation of epileptic discharges and raising the seizure threshold.
Is it true that surgical treatment is considered only when formal drug treatment is ineffective for more than two years?
The previous view is that intractable refractory epilepsy is the indication for epilepsy surgery. With the advancement of epilepsy diagnosis and surgical treatment techniques, the surgical efficacy of epilepsy surgery has been improving. For the types of epilepsy with good surgical results, early surgery is now advocated to avoid irreversible brain damage caused by long-term seizures. In particular, surgical treatment is preferred for epilepsy caused by cortical developmental malformations, brain tumors, cerebrovascular disease, and brain parasites.
What are the difficulties of epilepsy surgical treatment?
The core of epilepsy surgical treatment is the precise location of the epileptogenic foci, if the location is not correct, it is difficult to guarantee the effectiveness of epilepsy surgery. The biggest difficulty in epilepsy surgery is the preoperative localization, which often requires a combination of video EEG, MRI, PET-CT and other examinations as well as different information such as epilepsy symptomatology, neuropsychological assessment, wada experiments, and intracranial electrode EEG. Even so, there are still many patients with epilepsy in whom the lesion is difficult to localize. Of course, patients with difficulty in precise localization can be treated with palliative surgical modalities such as vagus nerve stimulation, corpus callosotomy, and multiple subchondral transection.
What are the indications for surgical treatment of epilepsy?
There are more indications for epilepsy surgical treatment. For patients with epilepsy with frequent seizures and accurate localization of the lesion, as long as there are no contraindications to surgical procedures, pre-surgical evaluation can usually be performed, and if the expected outcome is satisfactory, surgical treatment can be performed.
Can surgical procedures cure epilepsy?
Surgical procedures have been used for decades to cure epilepsy. With improvements in preoperative localization techniques and surgical techniques, the cure rate for epilepsy surgery continues to improve. Currently, surgical cure rates at top international epilepsy centers can reach over 70%. Of course, the surgical cure rate has a lot to do with case selection.
Do I still need to take medication after epilepsy surgery?
Generally, antiepileptic drugs are continued for more than 3 months after epilepsy surgery (some believe it is safer to take them for more than 2 years), after which the dosage is gradually reduced according to the EEG.
What are the surgical options for epilepsy?
The causes of epilepsy are complex and varied, and there are many different surgical procedures. Common surgical procedures include: standard anterior temporal lobectomy, epileptic focal resection, selective hippocampal amygdala resection, lobotomy, cerebral hemisphere resection, corpus callosotomy, multiple subchondral transverse fiber dissection, low-power cortical thermocoagulation, vagus nerve stimulation, and deep brain stimulation.
Is minimally invasive surgery for epilepsy feasible?
The concept of minimally invasive surgery is less clear. Traditional amygdala and hippocampal radiofrequency disruption (or gamma knife treatment) is not currently advocated due to poor efficacy, while vagus nerve stimulation, trigeminal extension stimulation, and deep brain stimulation are gradually being performed, but the efficacy is not too precise. It is worth mentioning that minimally invasive neurosurgery is not limited only to the size of skin incision and the length of operation time, but the maximum protection of brain function is the real sense of minimally invasive. Therefore, a relatively large skin incision is sometimes required for the sake of minimally invasive brain.
Is the use of intracranial electrodes necessary?
Intracranial electrodes are very important for epilepsy surgery. If we compare epileptic lesions to landmines, intracranial electrodes can be called minesweeping detectors. EEG is the basic means to diagnose epilepsy, and the accuracy of conventional scalp EEG localization is not high. Intracranial electrodes can directly detect the discharge in the cortex and deep brain tissue, and the diagnostic accuracy is greatly improved. However, for epileptic foci that have been very clearly localized, the use of intracranial electrodes is not very meaningful.
What is the success rate of epilepsy surgery?
For epilepsy surgery with limited lesions and accurate localization, the probability of no more seizures after surgery can reach more than 80%. In contrast, for palliative epilepsy surgery, it is difficult to achieve complete seizure freedom with surgical treatment. Therefore, the efficacy of epilepsy surgery is based on a thorough preoperative evaluation and accurate localization of the lesion. It is meaningless to generalize about the success rate of surgery.
Will I become stupid after epilepsy surgery?
The current surgical treatment of epilepsy is preceded by a rigorous preoperative evaluation. The surgery is relatively safe, and there is generally no postoperative delay in response, decreased intelligence, speech dysfunction, hemiparesis, or other conditions that are prone to occur with previous craniotomy. However, all surgery carries risks and surgeons cannot guarantee 100% safety.
Does epilepsy surgery have a significant impact on memory?
Memory loss is not uncommon in patients who underwent epilepsy surgery early in life, especially after medial temporal lobe resection of the dominant hemisphere. With advances in preoperative evaluation techniques and surgical techniques, current epilepsy surgery has a very limited impact on memory.