Stereotaxic Ablation of the Irritable Focus in Temporal Lobe Epilepsy

Epilepsy surgery in India

“…During the 1950s, 1960s, and the first half of the 1970s, several patients with uncontrolled epilepsies were operated on at CMC, Vellore, [10][11][12] and at the Institute of Neurology, Madras. [13,14] The localization of the epileptogenic focus was based on seizure semiology as obtained from history records, data from a scalp interictal EEG, and radiological investigations available then such as a skull radiograph, pneumoencephalogram, and carotid angiogram. In a recent retrospective analysis of 141 patients operated for epilepsy at CMC, Vellore, 102 (73%) had temoral resections, 23 (16%) had extratemporal resections, and 16 (11%) had multilobar resections.…”

“…[15] At the Institute of Neurology, Madras, steriotactic lesions were made in the amygdalo-hippocampal region for temporal lobe epilepsy and in the centro-median nucleus of the thalamus, the field of Forel, and in the internal capsule for generalized seizures and infantile spasms. [13,14] The Decline In the mid-seventies, like elsewhere in the world, epilepsy surgery took a dramatic downward trend in India as well. The retirement from active service of Dr. Jacob Chandy and Dr. Ramamurthi from the centers they almost single handedly developed, less than expected postoperative seizure outcome, availability of more effective antiepileptic drugs, and stigma associated with epilepsy surgery due to its mistaken identity with psychosurgery collectively contributed to this decline.…”

Prognosis in Stereotaxic Surgery in Madras

“…Because the trouble responsible for temporal lobe epilepsy is situated in most cases in the medial temporal regions, stereotaxic lesions have been made in these areas to alleviate temporal lobe epilepsy [60][61][62], The operation of temporal lobectomy which removes a large amount of the temporal lobe is considered to be an unnecessarily mutilating procedure and thus should be undertaken only when absolutely necessary. Stereotaxic surgery of the temporal lobe has benefitted a number of patients with temporal lobe epilepsy and this may be considered as the first step in surgical alleviation.…”

Contemporary Methodology of Stereotactic Neurosurgery

“…It was only a small step from here to establish the methodology in patients with pronounced epileptic activity during stereoelectroencephalography to eradicate the focus in the amygdalohippocampal complex. Thus, from the original position of stereotaxy as an auxiliary method of classical neurosurgery, it has now become a method of first choice [12], Radical classical hippocampectomy is only necessary when stereotactic coagula tion of the amygdalohippocampal complex becomes unsuccessful.…”