Preoperative Evaluation for Epilepsy Surgery (Bonn Algorithm)

 

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Summary

Epilepsy surgery has been established as a successful treatment in patients with drug-resistant focal epilepsies. Different standardized surgical approaches were developed for resective or functional treatment. Successful surgical treatment, however, necessitates a careful presurgical evaluation. Although there are international standards for non invasive and invasive presurgical procedures most centers differ in their diagnostic strategy. This article gives a survey of the Bonn Epilepsy surgery program whithin which more than 1300 patients have been treated. After the method of patient selection different we describe tools of non invasive and invasive evaluation. This article serves only as a description of current practice in one center with a relatively large volume of cases. It presents just one opinion of a specific group within a wide spectrum of possible algorithms for presurgical evaluation that have briefly been outlined for 33 centers in Engels book [[4]].

Zusammenfassung:

Die Epilepsiechirurgie stellt eine etablierte Behandlungsmethode bei Patienten mit pharmakoresistenter fokaler Epilepsie dar. Verschiedene standardisierte Operationsverfahren wurden entwickelt und werden individuell eingesetzt. Voraussetzung für eine erfolgreiche chirurgische Behandlung ist eine sorgfältige präoperative Abklärung mit nicht invasiven und invasiven Methoden. Obwohl diese Abklärung international standardisiert abläuft, gibt es Unterschiede in den diagnostischen Strategien. Der folgende Artikel stellt den prächirurgischen Algorithmus des Bonner epilepsiechirurgischen Programms vor, in dem bisher mehr als 1300 Patienten behandelt wurden. Nach der Patientenselektion werden die einzelnen Schritte der nicht invasiven und invasiven Abklärung dargestellt. Dieser Artikel beschreibt die Vorgehensweise eines Zentrums mit einer großen Patientenserie. Es wird die Strategie einer Arbeitsgruppe in einem Spektrum vieler verschiedener Algorithmen aufgezeigt, wie sie im Buch von Engels [[4]] für 33 Zentren dargestellt wurden.

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MD Thomas Kral

Department of Neurosurgery

University of Bonn

Medical Center

Sigmund Freud Strasse 25

53105 Bonn

Germany

Phone: +49/228/287-65-61

Fax: +49/228/287-47-58

Email: Thomas.Kral@ukb.uni-bonn.de