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ObjectiveWe analyzed trends in patients' characteristics, outcomes, and waiting times over the last 25 years at our epilepsy surgery center situated in Central Europe to highlight possible areas of improvement in our care for patients with drug-resistant epilepsy. MethodsA total of 704 patients who underwent surgery at the Brno Epilepsy Center were included in the study, 71 of those were children. Patients were separated into three time periods, 1996-2000 (n = 95), 2001-2010 (n = 295) and 2011-2022 (n = 314) based on first evaluation at the center. ResultsThe average duration of epilepsy before surgery in adults remained high over the last 25 years (20.1 years from 1996 to 2000, 21.3 from 2001 to 2010, and 21.3 from 2011 to 2020, P = 0.718). There has been a decrease in rate of surgeries for temporal lobe epilepsy in the most recent time period (67%-70%-52%, P < 0.001). Correspondingly, extratemporal resections have become more frequent with a significant increase in surgeries for focal cortical dysplasia (2%-8%-19%, P < 0.001). For resections, better outcomes (ILAE scores 1a-2) have been achieved in extratemporal lesional (0%-21%-61%, P = 0.01, at least 2-year follow-up) patients. In temporal lesional patients, outcomes remained unchanged (at least 77% success rate). A longer duration of epilepsy predicted a less favorable outcome for resective procedures (P = 0.024) in patients with disease duration of less than 25 years. SignificanceThe spectrum of epilepsy surgery is shifting toward nonlesional and extratemporal cases. While success rates of extratemporal resections at our center are getting better, the average duration of epilepsy before surgical intervention is still very long and is not improving. This underscores the need for stronger collaboration between epileptologists and outpatient neurologists to ensure prompt and effective treatment for patients with drug-resistant epilepsy.

Biomechanical material properties of the bridging brain veins are investigated experimentally (A Nikon light microscope was used for the histo-anatomical study and viskoelastic properties was measured on a MTS 858.2 Mini Bionix system ) and theoretically. The main goal of the developed theory was to formulate the biomechanical conditions (geometrical dimensions, viscoelastic properties of veins and blood fluid flow conditions) at which unstable behavior or even vein collapse can occur. The study of the geometry and topology of bridging veins was carried out by a magnetic resonance (Siemens Magnetom Symphony1,5 T) and a stereomicroscope (Nikon SMZ 1500) complemented with a digital camera (Nikon Coolpix E995) and Lucia Net software. From the biomechanical point of view, experimental findings can be summarized as follows: the existence of two types of venous brain systems; thin and thick wall veins with a one order difference in elastic modulus magnitude high sensitivity of the thin wall veins on the blood flow rate and extension or contraction on their structural stability the existence of continuing small wall vibration under physiological conditions Under small deformations conditions, the shear modulus was shown experimentally to be in the range (2÷4)·10 4 Pa with a Young modulus E= (0.6÷1.2)·10 5...