Epilepsy Surgery

At present, neurosurgery offers a wide spectrum of operative procedures for the operative treatment of pharmacoresistent epilepsy in childhood. Apart from differentiated neurophysiological and neuropsychological investigations, particularly the progress in imaging techniques has led to a more precise localisation of origin and propagation of the pathological discharges. However, not all cases are suitable for surgery, even if desperate. The various microsurgical procedures which are presented are associated with a surprisingly low mortality and morbidity, provided that sufficiently experienced staff is taking care of the juvenile patient. They range from a circumscript microsurgical lesionectomy to functional hemipherectomy and from multiple subpial transections to callosotomy. The operative results in respect to seizure control thus vary enourmously. They depend largely on the selection criteria of the respective centres and local referral patterns. Generally speaking, it would be preferable to operate on juvenile patients earlier than reported in historical series and even as practised today, since the outcome of surgery seems to be more favourable the shorter the duration of the seizure disease is. It is the task of the paediatricians to limit the testing of anticonvulsant drugs to a reasonable time and in case of an unsatisfactory result of conservative therapy to offer the choice of surgical treatment to these unfortunate patients.