epilepsy surgery matthew a. howard iii md professor and chairman department of neurosurgery...
TRANSCRIPT
![Page 1: Epilepsy Surgery Matthew A. Howard III MD Professor and Chairman Department of Neurosurgery University of Iowa](https://reader036.vdocuments.us/reader036/viewer/2022062715/56649d875503460f94a6be5b/html5/thumbnails/1.jpg)
Epilepsy Surgery
Matthew A. Howard III MDProfessor and Chairman
Department of NeurosurgeryUniversity of Iowa
![Page 2: Epilepsy Surgery Matthew A. Howard III MD Professor and Chairman Department of Neurosurgery University of Iowa](https://reader036.vdocuments.us/reader036/viewer/2022062715/56649d875503460f94a6be5b/html5/thumbnails/2.jpg)
Topics to Discuss
• Why surgery?• How are patients selected?• What tests are performed?• How are the operations carried out?
![Page 3: Epilepsy Surgery Matthew A. Howard III MD Professor and Chairman Department of Neurosurgery University of Iowa](https://reader036.vdocuments.us/reader036/viewer/2022062715/56649d875503460f94a6be5b/html5/thumbnails/3.jpg)
Why Surgery ?
• Risks versus benefits • Alternative management options
![Page 4: Epilepsy Surgery Matthew A. Howard III MD Professor and Chairman Department of Neurosurgery University of Iowa](https://reader036.vdocuments.us/reader036/viewer/2022062715/56649d875503460f94a6be5b/html5/thumbnails/4.jpg)
Human Brain Anatomy
![Page 5: Epilepsy Surgery Matthew A. Howard III MD Professor and Chairman Department of Neurosurgery University of Iowa](https://reader036.vdocuments.us/reader036/viewer/2022062715/56649d875503460f94a6be5b/html5/thumbnails/5.jpg)
Seizure Free Outcomes(as measured 2 years after resection surgery)
• Temporal Lobe (about 70 to 80%)
• Non-Temporal Lobe (about 50%)
• No surgery (< 10 %)
![Page 6: Epilepsy Surgery Matthew A. Howard III MD Professor and Chairman Department of Neurosurgery University of Iowa](https://reader036.vdocuments.us/reader036/viewer/2022062715/56649d875503460f94a6be5b/html5/thumbnails/6.jpg)
How are patients selected?
• Will being seizure free have a major impact on the patient’s life?
![Page 7: Epilepsy Surgery Matthew A. Howard III MD Professor and Chairman Department of Neurosurgery University of Iowa](https://reader036.vdocuments.us/reader036/viewer/2022062715/56649d875503460f94a6be5b/html5/thumbnails/7.jpg)
How are patients selected?
• Will being seizure free have a major impact on the patient’s life?
• Is the patient refractory to medical management?
![Page 8: Epilepsy Surgery Matthew A. Howard III MD Professor and Chairman Department of Neurosurgery University of Iowa](https://reader036.vdocuments.us/reader036/viewer/2022062715/56649d875503460f94a6be5b/html5/thumbnails/8.jpg)
How are patients selected?
• Will being seizure free have a major impact on the patient’s life?
• Is the patient refractory to medical management?
• Does the patient have a seizure focus that can be identified and safely resected?
![Page 9: Epilepsy Surgery Matthew A. Howard III MD Professor and Chairman Department of Neurosurgery University of Iowa](https://reader036.vdocuments.us/reader036/viewer/2022062715/56649d875503460f94a6be5b/html5/thumbnails/9.jpg)
What tests are performed?
• Scalp EEG (outpatient, and video-EEG)
![Page 10: Epilepsy Surgery Matthew A. Howard III MD Professor and Chairman Department of Neurosurgery University of Iowa](https://reader036.vdocuments.us/reader036/viewer/2022062715/56649d875503460f94a6be5b/html5/thumbnails/10.jpg)
What tests are performed?
• Scalp EEG (outpatient, and video-EEG)• Neuropsychological Tests
![Page 11: Epilepsy Surgery Matthew A. Howard III MD Professor and Chairman Department of Neurosurgery University of Iowa](https://reader036.vdocuments.us/reader036/viewer/2022062715/56649d875503460f94a6be5b/html5/thumbnails/11.jpg)
What tests are performed?
• Scalp EEG (outpatient, and video-EEG)• Neuropsychological Tests• Brain MRI
![Page 12: Epilepsy Surgery Matthew A. Howard III MD Professor and Chairman Department of Neurosurgery University of Iowa](https://reader036.vdocuments.us/reader036/viewer/2022062715/56649d875503460f94a6be5b/html5/thumbnails/12.jpg)
![Page 13: Epilepsy Surgery Matthew A. Howard III MD Professor and Chairman Department of Neurosurgery University of Iowa](https://reader036.vdocuments.us/reader036/viewer/2022062715/56649d875503460f94a6be5b/html5/thumbnails/13.jpg)
What tests are performed?
• Scalp EEG (outpatient, and video-EEG)• Neuropsychological Tests• Brain MRI• PET (Positron Emission Tomography)
![Page 14: Epilepsy Surgery Matthew A. Howard III MD Professor and Chairman Department of Neurosurgery University of Iowa](https://reader036.vdocuments.us/reader036/viewer/2022062715/56649d875503460f94a6be5b/html5/thumbnails/14.jpg)
![Page 15: Epilepsy Surgery Matthew A. Howard III MD Professor and Chairman Department of Neurosurgery University of Iowa](https://reader036.vdocuments.us/reader036/viewer/2022062715/56649d875503460f94a6be5b/html5/thumbnails/15.jpg)
What tests are performed?
• Scalp EEG (outpatient, and video-EEG)• Neuropsychological Tests• Brain MRI• PET (Positron Emission Tomography)• Wada Test
![Page 16: Epilepsy Surgery Matthew A. Howard III MD Professor and Chairman Department of Neurosurgery University of Iowa](https://reader036.vdocuments.us/reader036/viewer/2022062715/56649d875503460f94a6be5b/html5/thumbnails/16.jpg)
Wada Test
![Page 17: Epilepsy Surgery Matthew A. Howard III MD Professor and Chairman Department of Neurosurgery University of Iowa](https://reader036.vdocuments.us/reader036/viewer/2022062715/56649d875503460f94a6be5b/html5/thumbnails/17.jpg)
How are the operations carried out?
Directly to resection surgery
OR
Intracranial monitoring followed by resection
![Page 18: Epilepsy Surgery Matthew A. Howard III MD Professor and Chairman Department of Neurosurgery University of Iowa](https://reader036.vdocuments.us/reader036/viewer/2022062715/56649d875503460f94a6be5b/html5/thumbnails/18.jpg)
Awake Craniotomy Resection Surgery
![Page 19: Epilepsy Surgery Matthew A. Howard III MD Professor and Chairman Department of Neurosurgery University of Iowa](https://reader036.vdocuments.us/reader036/viewer/2022062715/56649d875503460f94a6be5b/html5/thumbnails/19.jpg)
![Page 20: Epilepsy Surgery Matthew A. Howard III MD Professor and Chairman Department of Neurosurgery University of Iowa](https://reader036.vdocuments.us/reader036/viewer/2022062715/56649d875503460f94a6be5b/html5/thumbnails/20.jpg)
Electrical Stimulation Functional Mapping:“Basic” and “Clinical” Research
![Page 21: Epilepsy Surgery Matthew A. Howard III MD Professor and Chairman Department of Neurosurgery University of Iowa](https://reader036.vdocuments.us/reader036/viewer/2022062715/56649d875503460f94a6be5b/html5/thumbnails/21.jpg)
Intracranial Monitoringfollowed by
Resection Surgery
![Page 22: Epilepsy Surgery Matthew A. Howard III MD Professor and Chairman Department of Neurosurgery University of Iowa](https://reader036.vdocuments.us/reader036/viewer/2022062715/56649d875503460f94a6be5b/html5/thumbnails/22.jpg)
General Clinical Research Center (GCRC)
![Page 23: Epilepsy Surgery Matthew A. Howard III MD Professor and Chairman Department of Neurosurgery University of Iowa](https://reader036.vdocuments.us/reader036/viewer/2022062715/56649d875503460f94a6be5b/html5/thumbnails/23.jpg)
Complications
• Infection
![Page 24: Epilepsy Surgery Matthew A. Howard III MD Professor and Chairman Department of Neurosurgery University of Iowa](https://reader036.vdocuments.us/reader036/viewer/2022062715/56649d875503460f94a6be5b/html5/thumbnails/24.jpg)
Complications
• Infection• Change in cognitive functions
![Page 25: Epilepsy Surgery Matthew A. Howard III MD Professor and Chairman Department of Neurosurgery University of Iowa](https://reader036.vdocuments.us/reader036/viewer/2022062715/56649d875503460f94a6be5b/html5/thumbnails/25.jpg)
Complications
• Infection• Change in cognitive functions• Depression
![Page 26: Epilepsy Surgery Matthew A. Howard III MD Professor and Chairman Department of Neurosurgery University of Iowa](https://reader036.vdocuments.us/reader036/viewer/2022062715/56649d875503460f94a6be5b/html5/thumbnails/26.jpg)
Complications
• Infection• Change in cognitive functions• Depression• Headaches
![Page 27: Epilepsy Surgery Matthew A. Howard III MD Professor and Chairman Department of Neurosurgery University of Iowa](https://reader036.vdocuments.us/reader036/viewer/2022062715/56649d875503460f94a6be5b/html5/thumbnails/27.jpg)
Complications
• Infection• Change in cognitive functions• Depression• Headaches• Stroke
![Page 28: Epilepsy Surgery Matthew A. Howard III MD Professor and Chairman Department of Neurosurgery University of Iowa](https://reader036.vdocuments.us/reader036/viewer/2022062715/56649d875503460f94a6be5b/html5/thumbnails/28.jpg)
Other Types of Epilepsy Surgery
![Page 29: Epilepsy Surgery Matthew A. Howard III MD Professor and Chairman Department of Neurosurgery University of Iowa](https://reader036.vdocuments.us/reader036/viewer/2022062715/56649d875503460f94a6be5b/html5/thumbnails/29.jpg)
Surgery Decision
=
Risk/Benefit Calculation