1. Epilepsy Surgery Matthew A. Howard III MD Professor and Chairman Department of Neurosurgery University of Iowa

2. Topics to Discuss Why surgery? How are patients selected? What tests are performed? How are the operations carried out?

3. Why Surgery ? Risks versus benefits Alternative management options

4. Human Brain Anatomy

5. Seizure Free Outcomes (as measured 2 years after resection surgery) Temporal Lobe (about 70 to 80%) Non-Temporal Lobe (about 50%) No surgery (< 10 %)

6. How are patients selected? Will being seizure free have a major impact on the patient’s life?

7. How are patients selected? Will being seizure free have a major impact on the patient’s life? Is the patient refractory to medical management?

8. 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?

9. What tests are performed? Scalp EEG (outpatient, and video-EEG)

10. What tests are performed? Scalp EEG (outpatient, and video-EEG) Neuropsychological Tests

11. What tests are performed? Scalp EEG (outpatient, and video-EEG) Neuropsychological Tests Brain MRI

13. What tests are performed? Scalp EEG (outpatient, and video-EEG) Neuropsychological Tests Brain MRI PET (Positron Emission Tomography)

15. What tests are performed? Scalp EEG (outpatient, and video-EEG) Neuropsychological Tests Brain MRI PET (Positron Emission Tomography) Wada Test

17. How are the operations carried out? Directly to resection surgery OR Intracranial monitoring followed by resection

18. Awake Craniotomy Resection Surgery

20. Electrical Stimulation Functional Mapping: “Basic” and “Clinical” Research

21. Intracranial Monitoring followed by Resection Surgery

22. General Clinical Research Center (GCRC)

23. Complications Infection

24. Complications Infection Change in cognitive functions

25. Complications Infection Change in cognitive functions Depression

26. Complications Infection Change in cognitive functions Depression Headaches

27. Complications Infection Change in cognitive functions Depression Headaches Stroke

28. Other Types of Epilepsy Surgery

29. Surgery Decision = Risk/Benefit Calculation