Surgery in epilepsy: state of the art

Preliminary explorations: The advent of magnetic resonance imaging and its capacity to detect fine structural injury and SPECT and PET functional imag ing as well as the generalization of EEC-video and the simplification of in tracranial electrode implantation techniques has given a whole new life to surgery in epilepsy. Preoperative explorations are shorter and less invasiv e, allowing surgery without implantation of intracranial electrodes in more than 70% of the cases. Surgery: New surgical techniques (subpial trasection, neuronavigation...) a nd improvement in well-known procedures (amygdalo-hippocampectomy...) has m ade it possible to propose lower risk procedures with minimal trauma (overa ll complication rate < 10%), particularly for temporal epilepsy where the s uccess rate is greater than 80%. Fundamental rule: The key to success however directly depends on rigorous a pplication of the fundamental rule of anatomo-electro-clinical correlation.