Electrophysiologically Guided Multitarget Stereotactic Intractable Epilepsy Surgery in Patients with Complex Epileptic Systems

Objective: The purpose of this study is to achieve beneficial treatment outcomes for severe intractable epilepsy patients using neurophysiologically guided stereotactic multitarget surgery. Material and methods: Ninety-three patients (64 men, mean age 25 y (SD – 11 y, range 6-57 y), mean duration of illness 18 y (range 3-36 y) underwent multitarget stereotactic cryosurgery guided by preand intraoperative depth electrode (stereoelectroencephalography – SEEG) evaluation. Multiple unilateral and bilateral amygdalatomies, partial anterior and total hippocampotomies, cingulotomies, fornicotomies, CM and DM thalamotomies, postero-medial hypothalamic, Forel-H-tomies, and fasciculus uncinatus lesions in individual combinations were performed according to SEEG findings. Results: The SEEG studies revealed the existence of complexly organized multistructural epileptic systems in cases of long-standing severe intractable epilepsy. Engel’s (1993) Class I outcome was achieved in 51%, worthwhile improvement (Classes II-III) was observed in 28% and no worthwhile improvement (Class IV) was observed in 21% of all patients. Remarkable normalization of the psycho-emotional state was achieved for patients with pre-surgical behavioral problems. No seizure, or cognitive, or memory states worsening was observed in this cohort of patients. The follow-up for seizures and behavioral abnormalities was up to10 years. Conclusion: Multitarget electrophysiologically guided stereotactic surgery can have a beneficial effect on seizure frequency and severity, and normalize psycho-emotional state and behavior in long-standing intractable epilepsy patients. We did not postsurgical decline in cognitive domain of our patients, and the benefits of seizure control using this technique, im our opinion,outweigh possible risk of cognitive decline.