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History of Epilepsy Surgery

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Surgical Treatment of Epilepsies

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Abstract

Trephinations, some of which may have been performed to treat post-traumatic epilepsy, are already known from the prehistoric era. According to the interpretation as mysterious phenomena, magic and phenomenologically oriented modalities were used to treat epilepsies in the Middle Ages. The beginning of modern epilepsy surgery is dated to 1886, when Victor Horsley, based on Hughlings Jackson’s findings, operated on strict neurophysiological principles. With availability of electroencephalography (Berger 1929), temporal epilepsies came to the focus. The epilepsy surgical spectrum had been completed with the introduction of callosotomy in 1940 by van Wagenen and Herren and anatomical hemispherectomy by Krynauw in 1950. Patho-anatomical studies and neuropsychological implications of epilepsy surgery have been acknowledged in the middle of the last century. An important milestone in the late twentieth century was the introduction of MRI facilitating detection of the structural basis of epilepsies. In parallel, microsurgical operation techniques facilitated refined surgical approaches, intraoperative mapping and monitoring provided functionally guided resection strategies, and neuronavigation enabled the surgeon to take advantage of anatomical and functional imaging data. During the last decades, minimally invasive surgical techniques including neurostimulation, stereotactically guided lesioning, and radiosurgery gained increasing interest to treat seizure foci carrying high risks for resection or epilepsies without evidence of a distinct seizure-onset zone. Major milestones in promoting epilepsy surgery were the Conference on Presurgical Evaluation of Epileptics in Zurich in 1986, the first Palm Desert Conference on Surgical Treatment of the Epilepsies held in California in the same year, and the follow-up Palm Desert conference in 1992, all contributing to the propagation and harmonization of strategies for both presurgical evaluation and surgical treatment of epilepsies.

History is who we are and why we are the way we are. History, despite its wrenching pain, cannot be unlived, but if faced with courage, need not be lived again. Those who cannot remember the past are condemned to repeat it.

David McCullough

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    Josef Zentner

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Zentner, J. (2020). History of Epilepsy Surgery. In: Surgical Treatment of Epilepsies. Springer, Cham. https://doi.org/10.1007/978-3-030-48748-5_1

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