Surgical treatment of frontal lobe epilepsy

Abstract

The surgical treatment of frontal lobe epilepsy (FLE) yields far less satisfactory results than that of temporal lobe epilepsy (TLE). To cope with this problem, we have introduced several new techniques, including intraoperative electrocorticography (ECoG) with sevoflurane anesthesia, corpus callostomy for diagnosis and treatment, and multiple subpial transection (MST) for eloquent cortices and extensively disseminated epileptic areas. General anesthesia was maintained by sevoflurane during surgery, and intraoperative ECoG was repeated after each procedure. When preoperative semiology suggested involvement of the bilateral frontal lobes or ECoG detected bilaterally synchronized epileptic discharges, anterior corpus callosotomy was performed before the main surgical procedure. MST was applied to unresectable motor or speech zones. This technique was also useful for treatment of widely disseminated epileptic zones. We obtained satisfactory results in surgical treatment of FLE. At >1 year of follow-up, >70% of the patients operated on have become seizure-free or almost seizure- free. Relevant combined use of ECoG, callosotomy, and/or MST has proved to be very effective in achieving satisfactory surgical results for treatment of FLE, especially when preoperative magnetic resonance imaging (MRI) does not detect any structural lesions.