A decade of experience in refractory epilepsy surgery in the Brazilian public health system: Long-term outcomes after 175 procedures.
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Epilepsy surgery represents a crucial therapeutic alternative for patients with drug-resistant epilepsy (DRE), particularly when pharmacological management fails to provide seizure control. This study presents a ten-year retrospective analysis of 175 surgical procedures performed at a Brazilian tertiary public health reference center. Both pediatric and adult patients were included, with resective surgeries predominating, especially for cases of mesial temporal sclerosis and long-term epilepsy-associated tumors. Surgical outcomes were evaluated using the International League Against Epilepsy (ILAE) classification after a minimum follow-up of two years. Overall, 62.3% of patients achieved complete seizure freedom (ILAE Class 1), with particularly favorable results in temporal lobe resections. Complication rates were consistent with international data, including intracranial hemorrhage (1.7%), cerebrospinal fluid fistula (1.7%), and visual field deficits (2.9%). Psychiatric disorders emerged in 6.3% of patients during follow-up. The histopathological spectrum revealed a predominance of mesial temporal sclerosis and tumors, with gliomas occurring at higher rates than typically reported internationally. These findings underscore the efficacy of epilepsy surgery in improving outcomes for DRE within the Brazilian Unified Health System, while also highlighting persistent challenges such as delayed referrals, technological limitations, and structural barriers to equitable access. Expanding surgical capacity and promoting earlier interventions remain essential to optimizing care in resource-limited settings.