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

Epilepsy Surgery

Matthew A. Howard III MDProfessor and Chairman

Department of NeurosurgeryUniversity 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

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 Monitoringfollowed 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