The location where a seizure arises is important to determine which “seizure focus” can be safely removed to cure epilepsy. The first step is to do a video-EEG (where seizure monitoring using scalp electrodes is done in a room with continuous video, to record seizures). This non-invasive method is successful in many cases, but in some cases electrodes must be placed inside the skull for a clearer recording. Seizure monitoring via an operation may involve placement of electrodes within or around the brain, used when electrodes on the scalp cannot sufficiently determine where a seizure is coming from. Electrodes may be placed using burrholes or craniotomy, with navigation.
Temporal lobectomy involves partial (not total) removal of the temporal lobe, which is done via a craniotomy using navigation for greater precision. Under general anesthesia, a small strip of hair is shaved using clippers, and then an incision made just in front of the ear to remove the seizure-causing region (middle temporal gyrus, inferior temporal gyrus, hippocampus, amygdala). The procedure generally lasts around two hours, and most patients stay 1-2 nights in the hospital. All seizure medications are still continued, and thusfar our experience has resulted in over 80% of patients being cured of their epileptic seizures, slightly higher than the reported rate in the literature. A multidisciplinary team is key, and we work closely with several neurologists (including epileptologists), neuroradiologists, neuropsychologist, and other specialists.
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