RESUMO
UNLABELLED: Progress in surgical treatment for unifocal epilepsy is evident. The efficiency of surgical treatment for multifocal epilepsy in cases when pathology of the brain is not seen on MRI remains to be inadequate and by large and large the problem is to be solved. MATERIALS AND METHODS: In 1978 to 2004, the epilepsy center of the Republic of Moldova performed 258 operations in 215 patients with drug-resistant epilepsy. These included 28 temporal lobectomies, 46 cortical resections, 151 stereotactic operations, 6 resection-and-stereotactic operations, and 27 implantations of diagnostic intracerebral electrodes (SICE). The operations were performed in a specialized operating suite. The authors developed stereotactic apparatuses, intracranial electrodes, and chemoelectrodes. Intraoperative diagnosis included video monitoring, echography, stereotactic electroencephalography (SEEG), electric studies, drug induction of a seizure, cortical anatomic and functional mapping, and determination of resection boundaries. Stereotactic destructions were made by diathermo- and cryotechniques. RESULTS: In temporal epilepsy, stereotactic hippocampotomy yielded good, satisfactory, and poor results in 23, 44, and 33% of cases, respectively. Amygdalohippocampotomy did these results in 33, 39, and 28%, respectively. Excellent and good results of open operations amounted to 42%. These of anterior temporal lobectomy were observed in 69%. CONCLUSIONS: 1. Stereotactic hippocampotomy is most effective in unifocal temporal epilepsy. Bilateral amygdalohippocampotomy has a marked psychosedative effect. 2. In 65%, the site of an epileptic focus failed to enable its resection to be radically made. 3. Temporal lobectomy is most beneficial in temporal epilepsy. 4. Intraoperative Talairach's SEEG, followed by resection is most effective in nontemporal epilepsy. 5. SICEs enhance the efficiency of resections by 2 times, stereotactic operations by 15%, without affecting the results of temporal lobectomy.