Functional frontal lobectomy in the surgical treatment of pharmacoresistant frontal lobe epilepsy: how I do it

Abstract

Abstract Background Frontal lobe epilepsy is pharmacoresistant in 30% of cases, constituting 10–20% of epilepsy surgeries. For cases of no lesional epilepsy (negative MRI), frontal lobectomy is a crucial treatment, historically involving Frontal Anatomical Lobectomy (AFL) with a 33.3% complication risk and 55.7% seizure control. Methods We describe Frontal Functional Lobectomy (FFL), in which the boundaries are defined on the patient's functional cortico-subcortical areas, recognized with advanced intraoperative technologies such as tractography and navigated transcranial magnetic stimulation (nTMS). Conclusions The FFL allows for a broader resection with a lower rate of postoperative complications than the AFL.