Introduction

Surgery for occipital lobe epilepsy has its own specific difficulties mainly related to the uncertainty of diagnosis and the visual loss associated with most resective surgery in the absence of an already existing visual deficit. In no other brain region is the patient and the surgical team confronted to such a degree with the possibility of a postoperative situation characterized by a poor result on the seizure tendency in addition to a new and permanent visual deficit. Consequently, all efforts must be made, often including SEEG intracranial recording, to prove the seizures are arising within a specific part of the occipital lobe and not for example within the temporal or parietal area.

The literature is sparse on the surgical treatment of occipital epilepsy and even more so on the modern surgical and technical aspects. In this chapter, a summary of the surgical anatomy of the occipital lobe and the clinical manifestations of occipital epilepsy, which are so crucial in establishing the hypothesis of the site of seizure onset, will be presented from a practical surgical perspective. Next, the technical aspects and various resection modalities will be addressed. The core of the presentation consists of an analysis of several representative cases with stress on the operative approaches, findings, and results.