Resective Epilepsy Surgery With Intraoperative Brain Mapping Techniques: Experiences From A Multidisciplinary Epilepsy Team In Egypt

Abstract

Purpose: Neurosurgery is an underutilized treatment that can potentially cure drug‐refractory epilepsy. Careful, multidisciplinary presurgical evaluation is vital for selecting patients and to ensure optimal outcomes. Resective epilepsy surgery is currently a standard treatment for intractable focal epilepsy. Seizure freedom and discontinuation of antiepileptic drugs are the ultimate goals of epilepsy treatment. We review our experience in initiating multidisciplinary team with low resource setting in a developing country and outcomes of resective epilepsy surgery using recent pre and intraoperative brain mapping and electrocorticography (ECoG) techniques for ensuring satisfactory resection of such cases. Materials and Methods: We performed a 2-years review of patients (n=50) with a diagnosis of intractable focal epilepsy, who underwent epilepsy surgery and were followed up for at least 12 months, and were evaluated for postoperative outcome. Pre-operative comprehensive clinical, neurophysiological, neuropsychological and radiological evaluation was performed by multidisciplinary epilepsy team. Intraoperative brain mapping techniques including awake craniotomy and direct stimulation techniques, neurophysiological monitoring and electrocorticography were carried out during surgical resection. Operative complications, neurological deficits, and extent of resection were evaluated. Engel class I–IV classification was the primary outcome measure of epilepsy surgery.  Results: There were 27 male and 23 female patients with a mean age of 16.3 years. 22 patients were temporal while 28 were extra-temporal. There were no major anesthetic complications. Postoperative immediate neurological deficit was seen in 4 patients 8% and this was permanent in only one patient (2%). The success rate as Engel class I was 76%. 12% and 8% of patients showed Engel class II and III respectively, while 2 patients (4%) showed no worthwhile improvement as Engel class VI. Conclusion:We found favorable outcomes after surgery in focal epilepsy patients after careful presurgical multidisciplinary selection, especially with using intraoperative brain mapping and electrocorticography techniques; so we believe that it is a major treatment option, even in less resource intensive settings, and should be encouraged. Dissemination of such knowledge and improving infrastructure may be considered an urgent clinical need especially in developing countries.