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.

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.

• 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)

• Temporo-parieto-occipital (posterior quadrant)
• Fronto-temporal
• Fronto-parietal
• Parieto-occipital

• 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

• 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

• 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

• Epilepsy Surgery
• Focal Cortical Dysplasia
• Posterior Quadrant Epilepsy
• Temporal Lobectomy