Deep learning enabled decision support systems in epilepsy surgery: a scoping review

Deep learning is increasingly explored to support decision-making in epilepsy surgery, yet evidence for implementation across the epilepsy surgery pathway remains limited. We conducted a scoping review of 145 studies published between January 2018 and May 2025 to map deep learning enabled decision support systems across surgical stages and clinical tasks, characterize datasets by modality, size, geographic provenance and accessibility, and synthesize modeling practices, external validation and workflow integration. The literature is heavily concentrated in the pre-operative stage, with no included intra-operative studies and relatively few post-operative applications. Most studies rely on small, single-center and non-public datasets and use supervised CNN-based models. External validation and workflow-integrated evaluation are uncommon, and only a minority of systems report semi-integrated clinical workflows. These findings highlight key gaps in generalizability, workflow readiness and equity, and inform priorities for multi-center data resources, rigorous cross-site evaluation and clinically meaningful endpoints to enable safe, scalable adoption.