Surgical resection as salvage therapy for super-refractory status epilepticus: a report of two cases

Objective: Super-refractory status epilepticus (SRSE) carries high mortality and morbidity when pharmacological treatments fail. We aimed to evaluate the efficacy of emergency surgical resection for terminating SRSE secondary to focal cortical dysplasia (FCD) and ganglioglioma (GG). Methods: We present two cases of SRSE caused by frontal lobe FCD and GG that were unresponsive to maximal medical therapy. Both patients underwent emergency resection of the epileptogenic zone after comprehensive presurgical evaluation. Results: In both cases, surgical intervention successfully terminated SRSE. Case 1, a 22-year-old female with left frontal FCD, achieved Engel Class IB outcome at 4 years and 5 months follow-up. Case 2, a 34-year-old female with right frontoparietal GG, remained seizure-free 4.5 months follow-up. No serious surgical complications occurred. Conclusion: Emergency epilepsy surgery may represent a life-saving therapeutic option for selected patients with SRSE and identifiable structural lesions. Our findings support the inclusion of surgical evaluation in SRSE treatment protocols when pharmacological interventions fail. Multimodal imaging and prompt surgical decision-making are crucial for successful outcomes.