Sedation for Epilepsy Surgery under Local Anesthesia

Performing craniotomy with the patient awake continues to represent an important option for the surgical management of patients with refractory epilepsy when intraoperative functional neurologic testing or electrocorticography (ECoG) are needed to define the extent of the corticectomy. The long duration of many neurosurgical procedures, the need to perform intraoperative functional cortical mapping and the unique sedation requirements associated with intraoperative ECoG recording pose substantial challenges for the neuroanesthetist. Advances in preoperative diagnosis and seizure focus localization and the use of standardized anterior temporal lobe resections have made the use of general anesthesia popular at some epilepsy centres. Provided that intraoperative functional cortical mapping is not required and localization can be achieved with confidence preoperatively, general anesthesia offers the most comfortable option for both the patient and the surgical team. This article reviews the important considerations associated with the choice of anesthetic technique for temporal lobe epilepsy surgery.