Epilepsy surgery classical indications are "lesional" epilepsies. MRI has accordingly oriented epileptologists towards the anatomical location of visible abnormalities and gradually given second place to the clinical and electrophysiological data relevant for surgical decision. One of the best examples is hippocampal atrophy. Despite of a huge number of papers and reports in literature, the rationale of temporal epilepsy surgery remains opaque or even contradictory, inviting to perform standard temporal lobectomy in presence of MRI hippocampal hypersignal and/or FDG-PET hypometabolism. Possibly the limited progress in TLE surgery outcome holds, at least in part, to such confusion between the localization of a visible lesion and the contour of its related epilepsy. Surgical outcome after temporal lobectomy is better than after amygdalo-hippocampectomy. Failures of temporal lobectomy are most of the time due to the extent of Epileptogenic Zone outside the temporal lobe. Therefore, hippocampus as the leading structure in temporal lobe epilepsy is likely a too simplistic view. Several aspects of TLE pathophysiology remain elusive and even the role of hippocampal sclerosis once epilepsy installed is ambiguous.
The aim of this workshop is to demonstrate and exemplify, through a practical and comprehensive approach, the utility of the stereoelectroencephalography methodology in mapping functional networks and their relations to "lesions," therefore figure out which structures are essential in the epileptogenic network at seizure onset and in spreading patterns.
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