Different surgical procedures in management of pharmacoresistant temporal lobe epilepsy: Review article

Abstract

Surgery was proven to be a very successful intervention for Temporal Lobe Epilepsy (TLE) that resist medical treatment. Many surgical procedures have been employed to treat TLE all over the last decades, these surgical procedures are mainly resective surgeries aiming at excision of the epileptogenic cortex to achieve seizure freedom but they differ according to the extent of the resections from extensive resection as in standard Anterior Temporal Lobectomy to more limited resections as in Selective Amygdalohippocampectomy and neocortical lesionectomy. Minimally Invasive stereotactic laser thermal ablation and stereotactic radiosurgery allow for selective destruction of the mesial temporal lobe structures as a substitute for surgical resection without harming nearby structures. Neuromodulation technologies, which include responsive neural stimulations, stimulation of the vagus nerve, and deep brain stimulations can be used also as palliative options in some individuals with TLE who aren’t candidate for resection or ablation but with lower rates of achieving complete seizure freedom. The choice of the appropriate procedure should be individualized as not all these surgical procedures are suitable for all the patients. Comprehension of the rational, indications and limitations of each procedure is essential for epilepsy surgeon to choose the optimum procedure for each patient.