Epilepsy surgery and Wada test/Epilepsi cerrahisi ve Wada testi

Wada test is an invasive procedure which can be used for several purposes in preoperative evaluation of drug resistant epilepsies. The most classical of these purposes is to determine the dominant hemisphere for language and predict the permanent postoperative language and memory deficits. Although it has been an established procedure and accepted as the gold standard in this aspect since 1960's, performing the procedure is not easy and involves some risks and there are considerable procedural differences among the epilepsy centers. The recent technological advancements accelerated the search for noninvasive alternatives for the Wada test; yet however, none of these alternatives (including the functional MRI) includes all the desired advantages while being free of the disadvantages of the Wada test. The accumulated experiences in the last fifty years show that not all the surgery candidates with temporal lobe epilepsy require the Wada test, however it still remains as the gold standard when the desicion is not straightforward. The authors, besides giving an overview of the contemporary literature, review their own experiences and provide practical suggestions about the Wada test in the presurgical evaluation of the patients with temporal lobe epilepsy. Key words: Epilepsy surgery; preoperative evaluation in epilepsy surgery; temporal lobe epilepsy; Wada test. Wada testi, ilaca direncli epilepsilerde epilepsi cerrahisi oncesi degerlendirmede cesitli amaclarla kullanilan invazif bir tetkik yontemidir. Bu amaclardan en klasik olani lisan acisindan dominant hemisferi belirlemek ve postoperatif kalici lisan ve bellek kusuru olup olmayacagini yordamaktir. 1960'lardan beri oturmus bir uygulama ve bu konuda altin standart haline gelmis olmasina karsin, uygulamasi cesitli zorluklar ve riskler icermektedir ve merkezler arasi farkliliklar gostermektedir. Gunumuzdeki teknolojk gelismeler, Wada testine alternatif olabilecek noninvazif yontemlerin aranmasini hizlandirmistir; ne var ki, bu yontemlerin hicbiri (islevsel MRG dahil) henuz arzulanan tum avantajlara sahip olmadiklari gibi, Wada testinin dezavantajlarinin tumunden de arinmis degillerdir. Son elli yildaki bilgi birikimi, temporal lob epilepsili olup cerrahi adayi olan her hastaya Wada testi uygulamanin gerekmedigine, ote yandan karar verme zorlugu olan hastalarda hala altin standart olmayi surdurdugune isaret etmektedir. Bu makalede yazarlar, konunun guncel literaturdeki degerlendirmesinin bir ozetinin yanisira