Multilobar Resection [Neurosurgery Wiki]

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====== Multilobar Resection ======

Multilobar resection is a type of [[epilepsy surgery]] performed in patients with [[drug-resistant focal epilepsy]] involving more than one cerebral lobe, typically within the same hemisphere.

===== 🔬 Definition =====
A **multilobar resection** refers to the surgical removal of cortical tissue from two or more lobes of the brain to eliminate or reduce seizures originating from a widespread, yet localizable, epileptogenic zone.

===== 🧠 Indications =====
  * Pharmacoresistant epilepsy with a well-defined multilobar epileptogenic zone
  * [[Focal cortical dysplasia]] (especially Type II)
  * Perinatal stroke or other structural lesions
  * [[Tuberous sclerosis complex]] with a dominant epileptogenic tuber
  * [[Posterior quadrant epilepsy]] (PQE)

===== 🛠️ Common Resection Patterns =====
  * Temporo-parieto-occipital (posterior quadrant)
  * Fronto-temporal
  * Fronto-parietal
  * Parieto-occipital

===== 🔍 Preoperative Evaluation =====
  * Scalp EEG and/or invasive monitoring (e.g., [[stereo-EEG]], [[subdural grids]])
  * High-resolution [[MRI]]
  * Functional neuroimaging: [[PET]], [[SPECT]], fMRI
  * Neuropsychological assessment
  * Functional mapping (motor, language, visual cortex)

===== ⚖️ Benefits vs. Risks =====
**Benefits**
  * Potential for seizure freedom (Engel I outcome)
  * Reduced seizure burden
  * Improved quality of life

**Risks**
  * Visual field defects (e.g., homonymous quadrantanopia)
  * Hemiparesis, aphasia, or cognitive deficits
  * Surgical risks: infection, hemorrhage, CSF leak

===== 📊 Outcomes =====
  * Seizure freedom in 50–70% of well-selected cases
  * Best outcomes achieved with complete resection of the epileptogenic zone
  * Prognosis worsens in cases with bilateral or poorly localized epilepsy

===== 🔗 Related Topics =====
  * [[Epilepsy Surgery]]
  * [[Focal Cortical Dysplasia]]
  * [[Posterior Quadrant Epilepsy]]
  * [[Temporal Lobectomy]]