Operative Techniques in Epilepsy by John P. Girvin

By John P. Girvin

This e-book describes the explicit surgical recommendations at the moment hired in sufferers with intractable epilepsy; it additionally covers the suitable technical elements of common neurosurgery. the entire ways linked to a few of the foci of epilepsy in the cerebral hemispheres are thought of, together with temporal and frontal lobectomies and corticectomies, parietal and occipital lobe resections, corpus callosotomy, hemispherectomy, and a number of subpial incisions. moreover, anyone bankruptcy is dedicated to electrocortical stimulation and practical localization of the so-called eloquent cortex. The extra basic themes on which assistance is equipped contain bipolar coagulation (with assurance of the actual ideas, energy of the coagulating present, use of coagulation forceps, some great benefits of right irrigation, and use of cottonoid patties) and all the measures required in the course of the functionality of operations lower than neighborhood anesthesia. The publication is designed to fulfill the necessity for a essentially orientated resource of targeted info at the operative systems hired in epilepsy sufferers and may be of particular worth for neurosurgical citizens and fellows.

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Post-operative Scar c Post-operative Scars 30 2 Techniques in Epilepsy Surgery violated, and a small vessel in the underlying subarachnoid space has been occluded, resulting in an infarct in the normal cortex across from the violated pia. There may be no clinical risk from this small infarct other than the birth of another epileptogenic focus, but if the cortex happened to be the eloquent cortex, then there may well be some associated neurological impairment. It is worth noting that this damage can be produced mechanically through the use of perfectly normal surgical instrumentation but which has been used without sufficient care.

This synonymy was not seriously challenged until the latter part of the last (twentieth) century. P. 1007/978-3-319-10921-3_3 37 38 3 Surgery Under Local Anesthesia The challenge to the practice of carrying out epilepsy surgery under local anesthesia became more understandable in the face of a number of rather important advances, which have evolved over the course of some 50 years. These included (1) the increasing experience of surgery, which led to a reasonably standard operative technique, especially in the case of anterior temporal lobectomy (aTLY); (2) the increased knowledge of the pathology and the location of epileptic foci, underlying the seizures of temporal lobe origin, residing in the antero-infero-mesial structures; (3) the increasing lack of dependence upon the intraoperative electrocorticography (ECoG) for the determination of the epileptic focus; (4) the remarkable improvement in identifying small morphological abnormalities through the continually improving medical imaging and the associated correlations between these and the electrographically identified epileptic foci; (5) the rather striking improvements in general anesthesia and neuroleptanalgesia, which, even when intraoperative ECoG is necessary, fail to adversely affect the ECoG, as it did in the early and middle part of the twentieth century; and (6) the use of preoperatively implanted ECoG electrodes, which not only provide evidence of localized epileptogenic discharges but also allow the preoperative electrocortical stimulation, which may provide the necessary functional localization to carry out the eventual operation satisfactorily under general anesthesia.

This has been discussed in detail elsewhere (Girvin 1986a) and will be briefly reviewed in the following. 2 Preparation of the Patient 41 terms, it is the achievement of a somewhat intangible cognitive and psychological preparedness. It is most important to provide the necessary communication and reassurance that guarantees that the patient understands fully the sequential steps of the procedure, particularly with respect to when he/she may or may not be uncomfortable, and that the whole team is there for one reason—the combination of both the comfort of the patient and the discharge of the individual responsibilities of the team that guarantee the best possible final outcome of the surgery.

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