Surgical Treatment of Temporal Lobe Epilepsy

Abstract

Surgical resection of epileptogenic cortex is an accepted treatment of intractable focal epilepsy (0jemann, 1983; Wyllie et al., 1987). It is now gener• ally accepted that the seizure-focus (i.e. the critical mass of neurons generating ictal EEG discharges produc• ing clinical seizures) is located within and does not extend beyond a larger zone called the "irritative id zone" which exhibits interictal EEG discharges between seizures. Accordingly, resection of the "irritative zone", while carrying the possibility of resecting more than is necessary, guarantees total resection of the seizure-focus (Cahan and Goldenburg, 1991; Awad and Nayel, 1992). In the early days of Wilder-Penfield and mi colleagues, surgery was carried out in the awake pa• tient under local anaesthesia. Intraoperative electro• corticography was performed and subsequently all areas of cortex showing interictal EEG discharges were resected (Foerster and Penfield, 1930). Penfield and co-workers thus resected the "irritative zone". Since such early attempts there has been a tremen• dous evolution in the methods of patient selection and surgical technique.