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Anesthesia

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Surgical Treatment of Epilepsies

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Abstract

Epilepsy surgery poses several considerable challenges to the anesthesiologist: (1) anticonvulsant therapy can adversely affect various organ systems, (2) effective intraoperative electrocorticography (ECoG) and electrophysiological mapping and monitoring require appropriate choice of anesthetics, and (3) extensive procedures like multilobectomy or hemispherectomy can be associated with homeostatic derangements, especially when performed during very early childhood. With availability of sophisticated tools for language mapping as well as for mapping and monitoring of sensorimotor functions, all surgical procedures for epilepsy can in principle be performed under general anesthesia. Overall, general anesthesia for epilepsy is similar to that for any craniotomy. However, intraoperative electrophysiological testing and electrocorticography require modifications. During the past decades, awake craniotomy has been reintroduced and has become an accepted technique for various neurosurgical interventions. Considerable progress in anesthetic techniques has facilitated this renaissance. Awake craniotomy can be managed under local anesthesia combined with moderate sedation or by modifications combining general and local anesthesia (asleep-awake-asleep and asleep-awake technique). Special expertise is required to assure patient comfort and successful outcome. Provision of safe and effective local anesthesia and sedation, and of smooth and predictably rapid transition from unconsciousness to a cooperative state, remains a major anesthetic challenge. As the procedural demands are considerable, performance of awake craniotomy should be restricted to centers with sufficient experience.

Life is pain and the enjoyment of love is an anesthetic

Cesare Pavese

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  1. Freiburg im Breisgau, Baden-Württemberg, Germany

    Josef Zentner

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Zentner, J. (2020). Anesthesia. In: Surgical Treatment of Epilepsies. Springer, Cham. https://doi.org/10.1007/978-3-030-48748-5_5

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