Decision Making in Epilepsy Surgery.

The need to emphasize the network concept arises from the fact that the traditional surgical philosophy in American epilepsy centers has prioritized an electrical-anatomic, focus-oriented approach. In contrast, the stereoelectroencephalography philosophy focuses on using electrophysiology to determine the regions of cortex generating the clinical manifestation of the seizure. Viewing epilepsy surgery as network surgery enables optimal consideration of decisions related to the need for and method of intracranial monitoring, potential role of subcortical structures in seizure organization and propagation, upfront use of combinatorial therapies to prevent seizure emergence from the network, and use of neuromodulation in novel epilepsy indications.