Anesthesia considerations in epilepsy surgery

- Preoperative evaluation.
- Proconvulsant and anticonvulsant effects of anesthetic agents.
- Anesthetic techniques for temporal lobe epilepsy.
- Vagal nerve stimulation.
- Cerebral hemispherectomy and corpus callosotomy.

Epilepsy surgeries can be done under general anesthesia or with local anesthesia and sedation. Epilepsy surgery done under general anesthesia have similar goals as any other neurosurgical procedure, except in patients with temporal lobe epilepsy requiring cortical mapping or electrocorticography (ECoG) where depth of anesthesia has to be reduced. Since seizure focus localization can be done preoperatively with modern diagnostic tools, general anesthesia is popular even for these patients. It is comfortable for both the surgeon and the patient. For intraoperative ECoG or cortical mapping awake craniotomy is the preferred technique.