%0 Journal Article
%T Surgical Techniques for the Treatment of Temporal Lobe Epilepsy
%A Faisal Al-Otaibi
%A Saleh S. Baeesa
%A Andrew G. Parrent
%A John P. Girvin
%A David Steven
%J Epilepsy Research and Treatment
%D 2012
%I Hindawi Publishing Corporation
%R 10.1155/2012/374848
%X Temporal lobe epilepsy (TLE) is the most common form of medically intractable epilepsy. Advances in electrophysiology and neuroimaging have led to a more precise localization of the epileptogenic zone within the temporal lobe. Resective surgery is the most effective treatment for TLE. Despite the variability in surgical techniques and in the extent of resection, the overall outcomes of different TLE surgeries are similar. Here, we review different surgical interventions for the management of TLE. 1. Introduction The first surgical intervention for the amelioration of epilepsy was performed by Horsley and involved a cortical resection in a patient suffering from posttraumatic epilepsy [1]. Cortical resection to treat epilepsy has since been performed by other surgeons [2¨C4]. Following the first human application of electroencephalography (EEG) by Berger in 1929 [5], EEG and electrocorticography (ECOG) were used by Penfield and Jasper to tailor resective surgeries for epilepsy [6, 7]; they modified cortical resections based on an extensive mapping of different cortical regions. Early in the practice of temporal lobe surgery to treat epilepsy, hippocampal preservation was advocated to avoid memory disruption [8¨C11]; however, Penfield observed that the failure to resect mesial temporal structures was associated with poor epilepsy control [7, 12]. Subsequently, surgery for temporal lobe epilepsy (TLE) has come to constitute the majority of resective epileptic surgical interventions. Several modifications have been made to the surgical techniques and methods used to treat epilepsy over the last 50 years. Modifications to temporal lobe resective surgery have been based either on resection of the epileptogenic zone, assisted by the use of ECOG and cortical mapping to avoid functional deficits, or on resection of the seizure onset zone, as with selective amygdalohippocampectomy (SAH). Functional deficits following temporal resection surgeries were identified early by Penfield and Scoville [9, 13]. Since that time, neuropsychological assessment has become a standard part of the multidisciplinary approach for the treatment of epilepsy. The primary goal of temporal lobe surgery is to achieve freedom from seizures without causing neurological or cognitive dysfunction. In turn, the achievement of this goal should improve psychosocial adjustment, education and employment status, and quality of life, as well as significantly reducing the overall treatment cost for patients [14, 15]. Although surgery is effective in the majority of patients with TLE, not all show
%U http://www.hindawi.com/journals/ert/2012/374848/