Convergence of Stereotactic Surgery and Epilepsy

TL;DRAbstract

Because successful resective epilepsy surgery relies on accurate preoperative localization of the epileptogenic zone (EZ), presurgical evaluation is necessary to obtain the widest and most accurate spectrum of information from clinical, anatomic, and neurophysiological aspects, with the ultimate goal of performing an individualized resection for each patient.1-3 Noninvasive studies are successful in identifying and anatomically delineating the EZ in approximately 70% of the patients who are operated on at the Cleveland Clinic Epilepsy Center (unpublished data). Consequently, a formulation of a clear anatomo-electro-clinical (AEC) hypothesis may not be possible in the remaining 30% of patients, or an AEC hypothesis is partially generated but the exact location of the epileptogenic area within a specific neuronal network, its extent, or its overlap with functional (eloquent) cortex remains unclear. In these clinical scenarios, when the noninvasive data are insufficient to define the EZ,

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