1 . Cerebral cortical resection is the most basic method of surgical treatment for focal epilepsy, and its aim is to remove the epileptogenic foci. This procedure is not recommended for those who have insufficient objective evidence of focal epilepsy, those with scattered epileptic foci, or those who cannot cooperate for long periods under local anesthesia. Intraoperative electrocorticography is performed, and deep electrode tracing is performed if necessary to limit the extent of resection in functional areas and to remove the epileptic foci as completely as possible. If there is no seizure and the EEG shows the disappearance of epileptic waves, the dosage will be gradually reduced until the drug is discontinued according to the condition. Tai Junli, Department of Functional Neurosurgery, Epilepsy Center, Beijing Luhe Hospital, Capital Medical University
2 . Anterior temporal lobectomy (ATL) This is a classical surgical method to treat anterior temporal lobe epilepsy. The efficacy is sure and the results are the best. Anna Kelemen et al. analyzed the seizure control of 94 patients after ATL, with a mean follow-up of 6.1 years, and 87% of patients were seizure-free within 2 years after surgery.
3 . Selective amygdalo-hippocampectomy (SAH) Through continuous research on the mechanism of temporal lobe epileptogenesis, it was found that the epileptogenic foci of temporal lobe epilepsy were mainly located in the amygdala, hippocampus, and parahippocampal gyrus of the limbic system, and Wieser and Yasargil in 1982, using microsurgical techniques, successfully In 1982, Wieser and Yasargil used microsurgical techniques to successfully remove these structures with good results. There are various approaches to SAH surgery, and the trans-lateral fissure approach is the most commonly used procedure today. This procedure is of great practical value because it can damage the temporal lobe to a small extent, is easy to operate, and preserves the visual and language functions of the lateral temporal lobe.
Hemispherectomy is indicated for patients with infantile hemiplegia with intractable epilepsy, Sturge-Weber syndrome (cerebral facial hemangiomatosis), hemifacial gigantism, and Rasmussen syndrome. The child should generally be operated before the age of 10 years, with total resection of the entire removed hemisphere, preserving the basal nucleus and thalamus. After surgery, functional areas are shifted and remodeled; limbic impairment is improved. richard et al. performed functional cerebral hemispherectomy in 12 infants with hemiplegia with intractable epilepsy, and the seizures disappeared or nearly disappeared in 76.2% of patients after surgery at an average follow-up of 38.8 months.
5 . Atsuko Matsuo et al. reported that the mechanism of corpus callosotomy was to reduce the frequency and severity of seizures rather than to convert the seizure form from generalized to partial seizures.
6 . Multiple subpial transection (MSF) This procedure was first reported in 1989. It is indicated when the epileptic foci are located in major cortical functional areas and cortical seizure foci cannot be resected, such as those in the anterior and posterior central gyrus, Broca’s area, Wernicke’s area, angular gyrus, and supramarginal gyrus. Xiaoping et al. used MST combined with focal resection to treat patients with intractable persistent epilepsy and achieved satisfactory results, and noted that MST is one of the main procedures preferred for the treatment of patients with intractable persistent epilepsy. However, the disadvantage is that this procedure is only applicable to epileptic foci in the convex part of the brain that can be revealed, and it is difficult to deal with epileptic foci deep in the cerebral sulcus.
Vagus nerve stimulation (VNS) is a new method of treatment for intractable epilepsy. It is a method to control seizures by placing a pulse transmitter (model 100 NEP generator) into the subcutaneous tissue of the patient’s chest and connecting the electrodes to the vagus nerve to provide intermittent vagal nerve stimulation. Currently, VNS is used as a routine treatment in many countries in Europe and the United States, mainly in patients with epilepsy who have difficulty with surgery or failed surgical treatment, with a significant efficiency of more than 50%.
8 . In 1973, Cooper discovered that stimulation of the cerebellum had a significant inhibitory effect on neural activity in the brain and spinal cord, and could inhibit experimental chronic epilepsy and cortical evoked activity, so he pioneered chronic cerebellar stimulation to treat epilepsy successfully. This procedure is mainly indicated for intractable epilepsy, where abnormal EEG is identified, IQ is 70 or higher, and intracranial occupational disease has been ruled out. It is most effective for generalized or localized epilepsy originating in the limbic system, but not for focal epilepsy in the motor-sensory cortex. It is a relatively safe, effective, and non-destructive procedure, and seizures disappear or are significantly reduced in 75% of patients after surgery.