Within the last five years, our doctors have performed more than 400 surgeries for extratemporal epilepsy. The latest technology, including improving MRI, stereo taxis and microsurgery techniques, have improved outcomes and made surgery available to many epileptics that were not considered candidates in the past.
Below, find frequently asked questions about extratemporal lobe surgery.
What is extratemporal epilepsy surgery?
Extratemporal epilepsy surgery refers to surgery outside of the temporal lobe.
This means the surgery does not include the temporal lobe, which is each of the paired lobes of the brain lying beneath your temples. This surgery is commonly performed for focal epilepsy syndromes arising in the frontal lobe ( located at the front of the head), parietal lobe (located at the top of the head) or occipital lobe (located at the back of the head).
Occasionally, the epilepsy arises from more than one lobe and is called multi-lobar epilepsy.
What makes extratemporal epilepsy surgery challenging?
This type of surgery is often more challenging than temporal lobe surgery. Anatomy plays a large role in surgical planning. Each lobe of the brain has important functional areas that may limit the amount of surgery that can safely be performed.
Another challenge involves localization of where the seizures start. Once outside of the temporal lobe, the brain becomes a big place and accurate localization of where the seizures start (ictal onset zone) becomes difficult.
What tests are needed before extratemporal epilepsy surgery can be performed?
Before surgery can be performed, many pre-operative tests are often necessary, including:
- Magnetic Resonance Imaging (MRI)
- Positron Emission Computed Tomography (PET)
- Mapping of blood flow (ictal SPECT) during a seizure
If a patient is found to be a good surgical candidate, what happens next?
Eventually if the patient is a suitable candidate, invasive mapping of ictal onset zones and functional areas can be done by utilizing subdural electrodes. These are thin sheets of platinum electrodes available in a variety of sizes and configurations.
The electrodes are placed directly over the brain area of interest during surgery. The patient then goes to the Epilepsy Monitoring Unit where recording and stimulation are performed. Lastly, the patient is taken back to the operating room for removal of the electrodes and surgical removal of the trouble zone.