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Neocortical Resections

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Epilepsy Surgery and Intrinsic Brain Tumor Surgery

Abstract

Neocortical lesional epilepsy can be caused by a large variety of tumors, ranging from well-circumscribed dysplasia and glioneuronal tumors to infiltrative gliomas. Gross total resection of brain tumors, if possible, is the mainstay of tumor therapy. In particular, glioneuronal tumors can be successfully resected, sometimes with minimal rim, even close to or within the eloquent cortex. The pathology of these focal tumors or also nontumors has a better prognosis than more widespread or diffuse lesions. Differentiation of tumor cases (tumors accompanied by epileptic seizures) and epilepsy cases (refractory epilepsy in the presence of a tumor) is crucial for the definition of the primary treatment goal and thus for the preoperative decision making and the need for further presurgical epilepsy evaluation. Modern diagnostic techniques enable more focused hypotheses of the epileptogenic zone thus making possible more precisely directed resection; however, there is no direct way to determine the epileptogenic zone. Surgical resection has to be adapted to these epilepsy-related findings in order to combine tumor and seizure relief, resulting in lesionectomy, extended lesionectomy, tailored resection, or even lobectomies [1]. The risk-benefit ratio is crucial. Therefore all means to reduce potential morbidity should be regularly applied (e.g., neuronavigation, intraoperative neurophysiologic monitoring, awake craniotomy, and cortical mapping).

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Authors and Affiliations

  1. Department of Neurosurgery, RWTH Aachen University, Aachen, Germany

    Hans Clusmann

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  1. Medical School, University Hospital of Larisa Medical School, University of Thessaly, Biopolis, Larisa, Greece

    Konstantinos Fountas

  2. School of Medicine, University of Thessaly School of Medicine, Biopolis, Larisa, Greece

    Eftychia Z. Kapsalaki

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Clusmann, H. (2019). Neocortical Resections. In: Fountas, K., Kapsalaki, E. (eds) Epilepsy Surgery and Intrinsic Brain Tumor Surgery. Springer, Cham. https://doi.org/10.1007/978-3-319-95918-4_13

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  • DOI: https://doi.org/10.1007/978-3-319-95918-4_13

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