Recent Advancement of Technologies and the Transition to New Concepts in Epilepsy Surgery

Fruitful progress and change have been accomplished in epilepsy surgery as science and technology advance. Stereotactic electroencephalography (SEEG) was originally developed by Talairach and Bancaud at Hôspital Sainte-Anne in the middle of the 20th century. SEEG has survived, and is now being recognized once again, especially with the development of neurosurgical robots. Many epilepsy centers have already replaced invasive monitoring with subdural electrodes (SDEs) by SEEG with depth electrodes worldwide. SEEG has advantages in terms of complication rates as shown in the previous reports. However, it would be more indispensable to demonstrate how much SEEG has contributed to improving seizure outcomes in epilepsy surgery. Vagus nerve stimulation (VNS) has been an only implantable device since 1990s, and has obtained the autostimulation mode which responds to ictal tachycardia. In addition to VNS, responsive neurostimulator (RNS) joined in the options of palliative treatment for medically refractory epilepsy. RNS is winning popularity in the United States because the device has abilities of both neurostimulation and recording of ambulatory electrocorticography (ECoG). Deep brain stimulation (DBS) has also attained approval as an adjunctive therapy in Europe and the United States. Ablative procedures such as SEEG-guided radiofrequency thermocoagulation (RF-TC) and laser interstitial thermal therapy (LITT) have been developed as less invasive options in epilepsy surgery. There will be more alternatives and tools in this field than ever before. Consequently, we will need to define benefits, indications, and limitations of these new technologies and concepts while adjusting ourselves to a period of fundamental transition in our foreseeable future.