Kostіuk K. Differentiated neurosurgical treatment of epilepsy.

The thesis is devoted to relevant issues of surgical treatment of severe forms of epilepsy. The clinical course and associated psychiatric disorders in patients with drug-resistant epilepsy were under the study and the course of mental disturbances regression after various surgical procedures was assessed. Based on these results, special indications were developed for different types of surgery in particular forms of epilepsy. The study is based on 418 observations, including 296 patients with symptomatic epilepsy and 122 with cryptogenic. Stereotactic surgery was performed in 285 cases: one- or two- sided cryoamigdalectomy, longitudinal hippocampectomy and anterior callosotomy. As well the efficiency of resection surgery in 37 patients with temporal lobe and in 29 patients with extratemporal lobe epilepsy was analyzed. It was shown that correspondence of the localization of structural brain lesion with epileptic bioelectrical activity in the zone of surgical resection provides best seizures control in the vast majority of patients. In other instances it is preferably to recommend functional stereotactic surgery, given its minimal invasiveness, safety and rather high efficacy. The study included 67 patients with brain arterio-venous malformations whose major clinical manifestations were seizures. In 22 cases microsurgical resection was performed, in 21 - endovascular embolization and 24 patients underwent stereotactic Gamma-knife radiosurgery. Control of seizures was mostly effective after open resection of arterio-venous malformations - 86.4% and after radiosurgery - 83.3%. At the same time after embolization procedure positive results were achieved only in 28.6% cases.Selection and application of particular type of surgical treatment should be based on the rate of the real expectations for a positive outcome, which should take into account the form of epilepsy, its clinical course, concomitant psychiatric disorders as well as nature of structural and functional alterations in the brain.