Artikel
Epilepsy surgery with the preservation of brain function
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Autoren
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N. Mikuni
- Department of Neurosurgery, Sapporo Medical University School of Medicine, Sapporo, Japan
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S. Miyamoto
- Department of Neurosurgery, Kyoto University Graduate School of Medicine, Kyoto, Japan
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N. Hashimoto
- National Cerebral and Cardiovascular Center, Kyoto, Japan
| Veröffentlicht: | 4. Juni 2012 |
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Gliederung
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Objective: Surgical treatment has been developed as an effective treatment for intractable epilepsy. With recent developments in neuroimaging, electrical stimulation and anesthesia, brain functions during neurosurgery can be identified more safely and precisely than ever before. This new technique may useful for establishing more effective surgical approaches for epilepsy which preserves brain function.
Methods: Surgical treatment for mesial temporal lobe epilepsy with resection of the anterior temporal lobe can eliminate disabling complex partial seizures in 70 to 80% of the cases. On the other hand, anterior temporal lobectomy in the dominant hemisphere often produces a deficit in verbal memory that could reduce intellectual levels. With regard to the area of resection, it would be ideal to preserve as much healthy brain as possible, if the surgical outcome in view of the seizures remains the same. We have applied subtemporal hippocampectomy which preserves the basal temporal language area and temporal stem.
Surgical outcomes for neocortical epilepsy are not as good as those for mesial temporal lobe epilepsy. The removal of epileptogenic cortices, which are often widely found in the brain, while maintaining intrinsic brain functions, can potentially cause severe neurological deficits. For better operative results in patients with intractable neocortical epilepsy, we have removed epileptogenic cortices within the functional area in selected patients, while continuously monitoring the neurological functions of the patients during the removal of the cortex under local anesthesia.
Results: Following subtemporal hippocampectomy while preserving the basal temporal language area and the temporal stem, verbal memory was significantly improved. Cerebral glucose metabolism improved in the areas receiving projections from the affected mesial temporal lobe. For neocortical epilepsy, we have examined the relationship between the pathophysiology of intrinsic epileptogenecity and the brain functions of patients. Furthermore, we discuss the mechanisms underlying the recovery from the neurological symptoms caused by resection of the MCDs in the eloquent area, which were identified by electric stimulation.
Conclusions: Epilepsy surgery which aims to preserves brain function would lead to both better surgical outcome and advanced neuroscience.
