Minimally Invasive Epilepsy Surgery

Seizure freedom is the single best predictor of quality of life in epilepsy, as recurrent seizures lead to significant morbidity and potentially increased mortality. While anterior temporal lobectomy (ATL) remains the most established and tested surgical therapy for temporal lobe epilepsy (TLE), new minimally invasive options have catalyzed a resurgence of interest in epilepsy surgery. This chapter highlights the role of radiofrequency thermoablation, stereotactic radiosurgery, and laser interstitial thermal therapy in the treatment of patients with drug-resistant focal seizures. The temporal lobe epilepsies are the most common type of drug-resistant epilepsy in adults, with mesial temporal sclerosis as the most common cause of mesial TLE. Surgical treatment of this disorder includes procedures such as ATL, sublobar ATL and selective amygadalohippocampectomy. Many types of lesions causing drug-resistant epilepsy have been treated with laser interstitial thermal therapy guided by magnetic resonance thermography.