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After an early burst of enthusiasm for surgical treatment of epilepsy in the 1950s, there was widespread disappointment with this approach. Dr. Theodore Rasmussen, the premier epilepsy surgeon of his generation, offered the following analysis: “It was the wrong surgeons operating on the wrong patients.” Interest in surgical treatment of epilepsy was rekindled in the 1980s and 1990s because of growing recognition of the burden of medical intractability and of increasing accuracy of localization, particularly with MRI. Progress occurred in two major areas: the visualization of mesial temporal atrophy, indicative of underlying mesial temporal sclerosis, and the demonstration during life of cortical dysplasia. Both lesions had previously been identified, only retrospectively, during pathologic examination.
Patients with hippocampal and amygdaloid atrophy and those with other temporal lesions demonstrated by high quality neuroimaging can now be surgically treated with very good results. There remains, however, a group of patients who have no mesial …
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