Epilepsy surgery is an effective treatment in many patients with drug-resistant focal epilepsies. An early decision for surgical therapy is facilitated by a magnetic resonance imaging (MRI)-visible brain lesion congruent with the electrophysiologically abnormal brain region. Recent advances in the pathologic diagnosis and classification of epileptogenic brain lesions are helpful for clinical correlation, outcome stratification, and patient management. However, application of international consensus classification systems to common epileptic pathologies (e.g., focal cortical dysplasia [FCD] and hippocampal sclerosis [HS]) necessitates standardized protocols for neuropathologic workup of epilepsy surgery specimens. To this end, the Task Force of Neuropathology from the International League Against Epilepsy (ILAE) Commission on Diagnostic Methods developed a consensus standard operational procedure for tissue inspection, distribution, and processing. The aims are to provide a systematic framework for histopathologic workup, meeting minimal standards and maximizing current and future opportunities for morphofunctional correlations and molecular studies for both clinical care and research. Whenever feasible, anatomically intact surgical specimens are desirable to enable systematic analysis in selective hippocampectomies, temporal lobe resections, and lesional or nonlesional neocortical samples. Correct orientation of sample and the sample's relation to neurophysiologically aberrant sites requires good communication between pathology and neurosurgical teams. Systematic tissue sampling of 5-mm slabs along a defined anatomic axis and application of a limited immunohistochemical panel will ensure a reliable differential diagnosis of main pathologies encountered in epilepsy surgery.

2nd Faculty of Medicine Motol University Hospital Charles University Prague Prague Czech Republic

Department of Clinical Neuroscience and Rehabilitation Institute of Neuroscience and Physiology The Sahlgrenska Academy University of Göteborg Gothenburg Sweden

Department of Epilepsy Clinic and Experimental Neurophysiology IRCCS Foundation Neurological Institute Carlo Besta Milan Italy

Department of Neuropathology Institute of Neurology University College London London United Kingdom

Department of Neuropathology Research Institute for Brain and Blood Vessels Akita Akita Japan

Department of Neuropathology University Hospital Erlangen Erlangen Germany

Department of Neurosurgery Sahlgrenska University Hospital Gothenburg Sweden

Department of Neurosurgery University Hospital Erlangen Erlangen Germany

Department of Swammerdam Institute for Life Sciences Center for Neuroscience University of Amsterdam Amsterdam The Netherlands

Departments of Clinical Neurosciences Community Health Sciences and Paediatrics Faculty of Medicine University of Calgary Calgary Alberta Canada

Departments of Paediatrics Pathology and Clinical Neurosciences University of Calgary and Alberta Children's Hospital Research Institute Calgary Alberta Canada

Epilepsy Center Cleveland Clinic Foundation Cleveland Ohio U S A

SEIN Epilepsy Institute in the Netherlands Heemstede The Netherlands

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