Neurosurgical Approaches to Epilepsy: Evolving Paradigms

Author(s): Paula Daniel*

Epilepsy, a chronic neurological disorder characterized by recurrent seizures, remains a significant challenge for clinicians, especially in cases where patients exhibit resistance to pharmacological treatments. Over the past few decades, neurosurgical interventions have evolved as critical therapeutic options for individuals with refractory epilepsy. This review explores the current and emerging neurosurgical approaches to epilepsy, highlighting the paradigms that have shaped modern practice. Traditional procedures, such as temporal lobectomy and lesionectomy, have long been established as effective for specific types of epilepsy, particularly temporal lobe epilepsy. However, advances in neuroimaging, electrophysiological mapping, and minimally invasive techniques have expanded the repertoire of surgical options, enabling more precise targeting of epileptogenic zones while minimizing collateral damage. The advent of neurostimulation techniques, including vagus nerve stimulation (VNS) and responsive neurostimulation (RNS), offers alternative pathways for managing epilepsy in patients unsuitable for respective surgery. Additionally, the exploration of laser interstitial thermal therapy (LITT) and focused ultrasound further represents the cutting edge of minimally invasive interventions. This article discusses the indications, efficacy, and limitations of these evolving surgical paradigms, underscoring the need for a personalized, multidisciplinary approach to optimize outcomes in epilepsy surgery. The future of neurosurgical treatment for epilepsy lies in continued innovation and the integration of advanced technologies to enhance precision, safety, and patient quality of life.

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