Epilepsy Surgery Matthew A. Howard III MD Professor and Chairman Department of Neurosurgery University of Iowa
Topics to Discuss Why surgery? How are patients selected? What tests are performed? How are the operations carried out?
Why Surgery ? Risks versus benefits Alternative management options
Human Brain Anatomy
Seizure Free Outcomes (as measured 2 years after resection surgery) Temporal Lobe (about 70 to 80%) Non-Temporal Lobe (about 50%) No surgery (< 10 %)
How are patients selected? Will being seizure free have a major impact on the patient’s life?
How are patients selected? Will being seizure free have a major impact on the patient’s life? Is the patient refractory to medical management?
How are patients selected? Will being seizure free have a major impact on the patient’s life? Is the patient refractory to medical management? Does the patient have a seizure focus that can be identified and safely resected?
What tests are performed? Scalp EEG (outpatient, and video-EEG)
What tests are performed? Scalp EEG (outpatient, and video-EEG) Neuropsychological Tests
What tests are performed? Scalp EEG (outpatient, and video-EEG) Neuropsychological Tests Brain MRI
What tests are performed? Scalp EEG (outpatient, and video-EEG) Neuropsychological Tests Brain MRI PET (Positron Emission Tomography)
What tests are performed? Scalp EEG (outpatient, and video-EEG) Neuropsychological Tests Brain MRI PET (Positron Emission Tomography) Wada Test
How are the operations carried out? Directly to resection surgery OR Intracranial monitoring followed by resection
Awake Craniotomy Resection Surgery
Electrical Stimulation Functional Mapping: “Basic” and “Clinical” Research
Intracranial Monitoring followed by Resection Surgery
General Clinical Research Center (GCRC)
Complications Infection
Complications Infection Change in cognitive functions
Complications Infection Change in cognitive functions Depression
Complications Infection Change in cognitive functions Depression Headaches
Complications Infection Change in cognitive functions Depression Headaches Stroke
Other Types of Epilepsy Surgery
Surgery Decision = Risk/Benefit Calculation