Extratemporal resective surgery for epilepsy.

Extratemporal resections were the most common early operations for epilepsy. This area is in need of further investigations, however, as relatively little progress has been made in management of these cases. The surveys from the Palm Desert Conferences on extratemporal resections with at least 1 year follow-up indicate that of the 825 patients operated between 1949 and 1984, 43.2% were said to be seizure free, 27.8% improved, and 29.1% not improved. Between 1986 and 1990, 768 patients underwent extratemporal resections, with 44.5% seizure free, 35.7% improved, and 19.8% not improved. Thus, there has not been a major improvement in the seizure-free outcomes, although more patients are undergoing surgical treatment and there are increases in the "improved" category. Moreover, these results are worse than those for temporal resections reported by the same surveys. As is apparent from this article, extratemporal epilepsies are very heterogeneous. The techniques of electrophysiology that have been so successful with temporal lobe epilepsy seem to be less so with many extratemporal epilepsies, however, suggesting that improved outcomes for those conditions especially may depend on new techniques, such as those based on imaging.