The Patient for Epilepsy Surgery

Epilepsy surgery as a treatment option is usually reserved for medically intractable epilepsy, when anticonvulsant medication has failed to achieve adequate seizure control and the seizure frequency impairs quality of life. Intraoperative brain mapping is often requested by the surgeon and necessitates special planning by the anesthesiologist to provide the best possible operating conditions. Awake craniotomy with the “asleep-awake-asleep” pattern can be considered as a technique in such procedures but requires cautious management for achieving maximum patient satisfaction. Certain patients are not appropriate candidates for craniotomy in the awake state, but general anesthesia can still be considered with specific considerations.