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Awake Craniotomy: Controversies, Indications and Techniques in the Surgical Treatment of Temporal Lobe Epilepsy

Published online by Cambridge University Press:  02 December 2014

Ramesh L. Sahjpaul
Ramesh L. Sahjpaul*
Affiliation:
Department of Clinical Neurological Sciences, Division of Neurosurgery, London Health Sciences Centre, London, ON, Canada.
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Abstract

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In 1886, Victor Horsley excised an epileptogenic posttraumatic cortical scar in a 23-year-old man under general anaesthesia and discussed his choice of anaesthesia: “I have not employed ether in operations on man, fearing that it would tend to cause cerebral excitement; chloroform, of course, producing on the contrary, well-marked depression.” His concerns regarding anaesthesia are reiterated 100 years later as evidenced by the ongoing controversy over the choice of anaesthetic in surgical procedures for epilepsy. The current controversies regarding the necessity for local anaesthesia in temporal lobe epilepsy operations concern the utility of electrocorticography in surgical decision making, its relationship to seizure outcome and the value of intraoperative language mapping in dominant temporal lobe resections. The increasing sophistication of pre-operative investigation and localization of both areas of epileptogenesis and normal brain function and the introduction of minimally invasive surgical techniques and smaller focal resections are changing the indications for local anaesthesia in temporal lobe epilepsy. Thus, indications which were previously absolute are now perhaps relative. This article reviews the current indications for craniotomy under local anaesthesia in the surgical treatment of temporal lobe epilepsy.

Type
Research Article
Information
Canadian Journal of Neurological Sciences , Volume 27 , Issue S1: Canadian Temporal Lobe Epilepsy Surgery Workshop , May 2000 , pp. S55 - S63
Copyright
Copyright © The Canadian Journal of Neurological 2000

References

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