Surgical Management of Refractory Epilepsy — WACS Viva & Clinical Scenarios (Functional Neurosurgery, Epilepsy, and Pain)

Exam-style surgical management of refractory epilepsy viva scenarios with examiner probes and model answers for Neurosurgery candidates.

Scenarios covered

• SCENARIO 1: A 24-year-old right-handed patient presents with drug-resistant focal impaired awareness seizures persisting despite maximal tolerated doses of carbamazepine and levetiracetam. Outline the systematic presurgical evaluation protocol required to establish surgical candidacy, detailing the roles and concordance criteria of electrophysiological, neuroimaging, and neuropsychological investigations.
• SCENARIO 2: Describe the surgical anatomy and step-by-step operative technique of a standard anterior temporal lobectomy with amygdalohippocampectomy in the language-dominant hemisphere. Specify the anatomical landmarks used to define the safe posterior margin of neocortical resection, the boundaries of the temporal horn, and the critical vascular structures that must be preserved.
• SCENARIO 3: Compare the anatomical trajectories, surgical corridors, and risk profiles of the transsylvian, transcortical (middle temporal gyrus), and subtemporal approaches for selective amygdalohippocampectomy in mesial temporal sclerosis.
• SCENARIO 4: Discuss the indications, surgical anatomy, operative technique, and complications of corpus callosotomy in paediatric and adolescent patients with refractory epilepsy presenting with atonic drop attacks.
• SCENARIO 5: Outline the classification, mechanisms of action, anatomical targets, and clinical efficacy of neuromodulatory interventions, including vagus nerve stimulation (VNS), deep brain stimulation (DBS), and responsive neurostimulation (RNS), in patients with non-resectable or multifocal drug-resistant epilepsy.