Epilepsy Surgery in the Last 10 Years: Advancements and Controversies.

Abstract

The past decade has witnessed a transformative evolution in epilepsy surgery, marked by the introduction and maturation of the so-called "minimally invasive interventions," neuromodulation strategies, and personalized surgical approaches. These developments have redefined treatment paradigms for drug-resistant epilepsy, offering safer, more targeted, and sometimes more effective alternatives to traditional open resections. The 2025 AES Surgery Symposium served as a platform for synthesizing the state-of-the-art in this dynamic field, highlighting not only the significant strides made in surgical and neurotechnological innovation but also the unresolved controversies that continue to shape clinical practice. This review aims to distill key themes from the symposium, including emerging surgical techniques, the resurgence of stereo-electroencephalography (SEEG)-guided thermocoagulation, the further integration of neuromodulation into mainstream epilepsy care, and the future of individualized surgical planning through advanced imaging and connectomics. While these innovations hold remarkable promise, their efficacy, accessibility, and long-term impact require rigorous scrutiny and global discourse.