{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,7,17]],"date-time":"2026-07-17T10:05:20Z","timestamp":1784282720893,"version":"3.55.0"},"reference-count":46,"publisher":"Scientific Scholar","content-domain":{"domain":["surgicalneurologyint.com"],"crossmark-restriction":true},"short-container-title":[],"abstract":"\n Background:<\/jats:title>\n Frontal lobe epilepsy (FLE) surgery often requires complex presurgical evaluations and intraoperative monitoring, which may not be readily available in resource-limited settings. We report our experience establishing FLE surgical services in Indonesia to develop strategies for a simple but reliable service in low- and middle-income countries.<\/jats:p>\n <\/jats:sec>\n \n Methods:<\/jats:title>\n We included patients who underwent FLE surgery between 2003 and 2023 in Semarang, Indonesia. These patients underwent surgery with at least 12 months of follow-up. Univariate and multivariate Firth penalized logistic regression analyses were performed to identify factors associated with surgical outcome, stratified by follow-up duration. Kaplan\u2013Meier survival analysis and log-rank tests were performed to assess time-to-seizure recurrence across subgroups.<\/jats:p>\n <\/jats:sec>\n \n Results:<\/jats:title>\n \n 87 FLE surgeries were performed over a period of 20 years. Approximately 60% of the patients were pediatric. Most patients (63.2%) showed visible focal cortical dysplasia on imaging. At the \u22655-year follow-up group, 56.8% of the patients had Engel Class I disease, with 79.3% have favorable (productive) functional outcomes. Among factors associated with postoperative outcomes, the number of anti-seizure medicines \u22653 was a significant seizure-free predictor at \u22655-year follow-up (odds ratio 0.18, 95% confidence interval 0.04\u20130.87,\n p<\/jats:italic>\n = 0.033). The median seizure-free survival was 10.0 years for the overall cohort.\n <\/jats:p>\n <\/jats:sec>\n \n Conclusion:<\/jats:title>\n Despite several limitations, this research suggests that establishing routine FLE services in countries with limited resources is feasible. To maintain a simple but reliable service, a streamlined surgery pathway should be introduced, together with strengthening national capacity and adopting cost-efficient technology.<\/jats:p>\n <\/jats:sec>","DOI":"10.25259\/sni_65_2026","type":"journal-article","created":{"date-parts":[[2026,7,17]],"date-time":"2026-07-17T09:22:25Z","timestamp":1784280145000},"page":"403","update-policy":"https:\/\/doi.org\/10.25259\/crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["Twenty years of frontal lobe surgery: Clinical outcomes and lessons from the frontier"],"prefix":"10.25259","volume":"17","author":[{"given":"Zainal","family":"Muttaqin","sequence":"first","affiliation":[{"name":"Department of Neurosurgery, Faculty of Medicine, Universitas Diponegoro, Semarang, Indonesia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jacob","family":"Bunyamin","sequence":"additional","affiliation":[{"name":"Department of Neurosurgery, Faculty of Medicine, Universitas Diponegoro, Semarang, Indonesia"},{"name":"Department of Anatomy-Histology, Faculty of Medicine, Universitas Diponegoro, Semarang, Indonesia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Novanda Rizky","family":"Radityatama","sequence":"additional","affiliation":[{"name":"Department of Neurosurgery, Faculty of Medicine, Universitas Diponegoro, Semarang, Indonesia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Muhammad","family":"Kamil","sequence":"additional","affiliation":[{"name":"Department of Neurosurgery, Faculty of Medicine, Universitas Diponegoro, Semarang, Indonesia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Muhamad Thohar","family":"Arifin","sequence":"additional","affiliation":[{"name":"Department of Neurosurgery, Faculty of Medicine, Universitas Diponegoro, Semarang, Indonesia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Aris Catur","family":"Bintoro","sequence":"additional","affiliation":[{"name":"Department of Neurology, Faculty of Medicine, Universitas Diponegoro, Semarang, Indonesia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Vega","family":"Karlowee","sequence":"additional","affiliation":[{"name":"Department of Anatomical Pathology, Faculty of Medicine, Universitas Diponegoro, Semarang, Indonesia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Happy Kurnia","family":"Brotoarianto","sequence":"additional","affiliation":[{"name":"Department of Neurosurgery, Faculty of Medicine, Universitas Diponegoro, Semarang, Indonesia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ajid","family":"Risdianto","sequence":"additional","affiliation":[{"name":"Department of Neurosurgery, Faculty of Medicine, Universitas Diponegoro, Semarang, Indonesia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Krisna Tsaniadi","family":"Prihastomo","sequence":"additional","affiliation":[{"name":"Department of Neurosurgery, Faculty of Medicine, Universitas Diponegoro, Semarang, Indonesia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Dody","family":"Priambada","sequence":"additional","affiliation":[{"name":"Department of Neurosurgery, Faculty of Medicine, Universitas Diponegoro, Semarang, Indonesia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Fariz Eka","family":"Setiawan","sequence":"additional","affiliation":[{"name":"Department of Neurosurgery, Faculty of Medicine, Universitas Diponegoro, Semarang, Indonesia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Rafi","family":"Ilmansyah","sequence":"additional","affiliation":[{"name":"Department of Neurosurgery, Faculty of Medicine, Universitas Diponegoro, Semarang, 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