☄Most beneficial in partial seizures secondary to a structural lesion
☄For determining the cerebral dominance and hence the location of speech , a WADA test (intracarotid injection of anesthetic to localize language function ; hence invasive) or recently functional MRI mapping (non invasive) of speech centres are done preoperatively
☄Simultaneous recordings of video EEG and MRI or PET scans can show the epileptogenic focus
☄Temporal lobe surgery may involve:
✔️removal of only the structural lesion & associated epileptogenic cortex
✔️cortical resection alone
✔️excision of amygdala and hippocampus
✔️removal of the entire anterior temporal lobe (extent of posterior resection dependent on dominance)
✔️depending on the local protocol, intraoperative Electro Corticogram (ECoG) may be used; anesthesia has to be modified accordingly
✔️if speech centre has to be located intraoperatively, an awake craniotomy is required
✔️ So depending on the surgical plan, choice of anesthesia varies
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