Detailed interviews of epileptic seizures are important for the diagnosis of epilepsy and for also determining the optimal treatment modalities. Epilepsy surgery is commonly effective in patients with focal epilepsy. These patients have characteristic seizure features which depend on the location of the focus. For example, complex partial seizures are characteristic in the temporal lobe epilepsy, seizures related to motor functions are common in frontal lobe epilepsy, somatosensory seizures are also sometimes observed in parietal lobe epilepsy and visual auras are frequent in occipital lobe epilepsy. Corpus callosotomy is beneficial in some types of generalized epilepsies, such as drop attacks. Furthermore, the elimination of seizures can sometimes be achieved by a single resection of cortical lesions in some epilepsy patients with multiple cortical lesions. When considering epilepsy surgery, a precise analysis of such seizures is essential for accurately identifying the epileptic focus and thus obtaining good surgical results.

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In patients with partial epilepsy, carbamazepine is the first choice antiepileptic drug (AED) and phenytoin or zonisamide may be the second. Monotherapy should be tried first with maximal dose, avoiding adverse effects. If the first AED fails to control seizures, the second monotherapy should be tried. If the second AED fails, the third or fourth AED would most likely fail. In such patients, surgical treatments are recommended, as their seizures can be judged as medically intractable. Once epilepsy surgery is planned, physicians may change AEDs to the most appropriate ones and reduce their doses as much as possible. After controlling seizures for 1-2 years post-operatively, physicians may start to withdraw AEDs. In such cases, risk factors of recurrence, such as duration of illness or normal pre-surgical MRI, should be considered. Furthermore, psychosocial states of patients should be also kept in mind.

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Focal cortical dysplasia (FCD) is defined as circumscribed malformation of cortical development, and it often causes medically refractory epilepsy. Palmini et al. (2004) have classified FCD into 2 types (I and II) and 2 subtypes (A and B) each. Of our 42 patients with FCD diagnosed pathologically, patients with type IIB had significantly more frequent seizures than patients with other types. In all patients with type IIB and 2 of 13 patients with type IIA, FCD was identified as a high signal intensity lesion on MRI; proton-dense weighted images were more sensitive than T2 weighted images and fluid-attenuated inversion recovery images. However, FCD type IA/IB could not be identified on MRI. Chronic EEG recordings of subdural and depth electrodes disclosed frequent interictal spikes and electrical seizure onsets within FCD lesions, and these findings suggest that FCD itself has intrinsic epileptogenicity. The basic procedure of surgical treatment for FCD is multiple gyrectomy including the whole FCD lesion. In cases with negative MRI, chronic intracranial EEG recording is necessary to tailor multiple gyrectomy. In our series, all patients with FCD type IIB and 10 (76.9%) of 13 patients with FCD type IIA achieved seizure freedom (Engel class I), whereas 9 (47.4%) of 19 patients with FCD type I were free from seizures. In conclusion, patients with MRI negative-FCD should have multimodal presurgical evaluations to more precisely delineate the lesions.

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Intractable epilepsy associated with organic lesions in MRI is generally a good candidate for surgical treatment. Meticulous localization of the epileptic focus is required even in patients with MRI lesions when surgical treatment is considered for abolishment of the seizures. Initial noninvasive evaluation includes recording of seizures and analysis of semiology, interictal and ictal electroencephalography (EEG), magnetoencephalography, and nuclear medicine studies. The final determination of epileptic focus is made in principle by intracranial EEG, particularly when noninvasive examinations do not lead to a decisive result and when a high spatial resolution is required for tailored resection of the epileptic focus. While intracranial EEG is presently the most useful method and a gold standard for localization of epileptic focus, it is unignorably invasive for patients. Further identification of patients in whom intracranial EEG can be skipped and development of a novel approach in localization and treatment of epileptic focus are urgently required.

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There is ongoing controversy in the field regarding the optimal extent of resection of peritumoral tissues to control epilepsy associated with brain tumor. Detailed evaluation and resection of epileptogenic surrounding brain tissue in addition to complete resection of tumor, is now referred to as "lesionectomy" in epilepsy surgery. For patients with intractable epilepsy associated with benign brain tumor, this type of surgery may provide a potential cure not only for the tumor but also for the concomitant epilepsy. Based on pathophysiological consideration regarding both brain tumor and epilepsy, intractability of the epilepsy and location of the tumor are important factors to decide the type of surgery. For brain tumor without intractable epilepsy, removal of the tumor would lead to seizure control and anticonvulsant prophylaxis may not be necessary. For intractable epilepsy associated with brain tumor, hippocampal sclerosis should be diagnosed for temporal lesions. Intraoperative elecrtocorticography and/or subdural electrode implantation must be considered for patients with severely intractable epilepsy, lesions in the eloquent area, and tumors with cortical dysplasia. Tumors should be removed before the associated epilepsy becomes intractable.

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Proton magnetic resonance spectroscopy (^1HMRS) is an effective noninvasive diagnostic tool that provides specific metabolic information not offered by other imaging methods. Consequently, is has become an important modality in the diagnosis of brain tumors. The combination of ^1HMRS, routine magnetic resonance imaging (MRI) and functional MRI yields valuable information for tumor grading and for differentiating between radiation necrosis and tumor recurrence and for distinguishing between tumors and non-neoplastic lesions. This review describes the techniques, parameters, and clinical applications of ^1HMRS.

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We reported a case of a symptomatic pineal cyst, which was successfully treated by neuroendoscopy. An 11-year-old girl's, who presented with intermittent headache, MRI showed a pineal cyst and accompanying obstructive hydrocephalus. Neuroendoscopy was used to resect a pineal cyst. Postoperative imaging showed a reduction of the cyst and resolution of the hydrocephalus. Traditionally, symptomatic pineal cysts are managed by open surgery or stereotactic aspiration. Recently, neuroendoscopy has been recommended as a third option. We review the literature and summarize the clinical features, radiological diagnosis, and treatment.

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Cervical ribs are usually an incidental congenital anomaly. Symptomatic cervical rib cases are rare. We experienced a case of thoracic outlet syndrome (TOS) caused by cervical rib. A 20-year-old male presenting with pain, paresthesia and weakness the of neck, right shoulder and arm was admitted to our hospital. This case was diagnosed as TOS caused by cervical rib by physical and radiological examination. This patient underwent cervical rib resection, and his preoperative symptoms disappeared. We discussed surgical treatment for symptomatic cervical rib with an investigation of the literature.

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