Controlling epilepsy is not always easy. However, uncontrolled seizures can be dangerous for a person living with epilepsy. If medications alone are not enough to control seizure activity, a neurosurgeon or neurologist may recommend epilepsy surgery. Thanks to advances in science and medicine, there are more surgery options for epilepsy now than ever before.
Epilepsy surgeries typically involve removing a small part of the brain that is responsible for generating seizures. Epilepsy surgery might also involve implanting a device in the brain that helps control seizures.
Surgery for epilepsy can be a very effective treatment. Research shows that between 36 percent and 100 percent of adults and children who undergo epilepsy surgery are seizure-free for at least one year, depending on their type of epilepsy and the type of surgery.
There are many types of surgery for different types of epilepsy. It is important that the type of surgical treatment is appropriately matched to a person’s type of epilepsy.
A focal resection is when a surgeon removes the point in the brain from which seizures begin. Typically, this method is used when there is a brain abnormality that is causing seizures. This type of surgery is most successful when the brain abnormality, as seen in MRI imaging, occurs in the same spot where seizures start based on electroencephalogram (EEG) monitoring. Brain mapping is also performed to determine the locations within the brain that are responsible for critical brain functions — such as speech, memory, movement, and vision — to avoid them during surgery. Research shows that a tailored resection of the site of a brain abnormality (such as a tumor or other lesion) that includes the seizure zone around it is more effective than a simple lesionectomy (only taking out the tumor itself).
A focal resection does not have to be a small area. Large portions of the temporal lobe or frontal lobe can be removed. According to the Epilepsy Foundation, the most common type of epilepsy surgery is an anterior temporal lobectomy (or resection of the lobe). This surgery also has the highest rate of success and is performed for certain people living with temporal lobe epilepsy.
Similarly, for frontal lobe epilepsy, a frontal lobe surgical resection may be performed. This is the second most common location for epilepsy surgery. People with frontal lobe epilepsy often have problems with cognitive abilities like concentrating, planning, or organizing. Frontal lobe resection has been shown to eliminate seizures in up to 50 percent of cases, while generally maintaining cognitive function after surgery.
Focal epilepsy can sometimes be controlled by removing the part of the brain in which focal seizures begin. This is usually done when the seizures are caused by structural anomalies (such as abnormal blood vessels, brain tumors, or scar tissue). Research has also shown that this type of surgery is successful in children with glioneuronal brain tumors.
In a multiple subpial transection procedure, a neurosurgeon makes a series of delicate, shallow cuts (transections) into the brain’s gray matter. This procedure can disrupt electrical activity across the brain and, thus, reduce seizure activity. This type of surgery is performed when focal seizures begin in places where resection is not an option — in parts of the brain that control critical functions like speech and movement, for example.
This type of surgery can also be done along with other types of epilepsy surgery. In one study of individuals who had multiple subpial transections plus resection surgery, excellent outcomes (greater than 95 percent decrease in seizure frequency) were observed in 87 percent of participants for generalized seizures, 68 percent for complex partial seizures, and 68 percent for simple partial seizures. For people who underwent multiple subpial transections without resection surgery, the rate of excellent outcomes was only a bit lower — 71 percent for generalized seizures, 62 percent for complex partial seizures, and 63 percent for simple partial seizures.
Laser interstitial thermal therapy is very different compared to standard surgical resections for epilepsy. It does not involve opening up the skull or the brain, or removing any part of the brain. It is considered a minimally invasive procedure.
First, the area of the brain causing seizure activity is determined with an MRI scan. Then, an extremely accurate laser is used to destroy the seizure focus area discovered through the MRI imaging. This type of therapy has been shown to be effective for mesial temporal lobe epilepsy that cannot be controlled with medication.
An anatomical hemispherectomy is the removal of most of one side of the brain where seizure activity occurs. This is considered to be a very invasive course of treatment. It is usually only performed in children with severe epilepsy that is not responsive to other types of treatment. It can be a treatment option for children who have Rasmussen’s encephalitis, hemimegalencephaly, Sturge-Weber syndrome, or congenital malformations of brain development. It can also be an option for children who experienced large strokes around the time of birth.
A functional hemispherectomy is a form of epilepsy surgery that involves removing a small area of the side of the brain affected by seizures and then disconnecting the remaining tissue from the rest of the brain. Both anatomical and functional hemispherectomy have been used successfully to treat hemispheric epilepsy that does not respond to medical treatment.
A hemispherotomy is different from hemispherectomy in that much less brain tissue is removed. This decreases the risk of complications from surgery. In this type of surgery, the surgeon makes a hole or several holes in the affected hemisphere to disrupt electrical activity. This technique is also used for hemispheric epilepsy not controlled by medication, hamartomas (benign masses of tissue) in the hypothalamus, and some other forms of epilepsy.
In a corpus callosotomy, the large band of connective tissue that bridges the two hemispheres of the brain (the corpus callosum) is disconnected. This type of surgical procedure is used for severe generalized epilepsy. This surgery helps prevent excessive electrical activity from crossing from one side of the brain to the other. It is usually performed on children with severe epilepsy that does not respond to medication.
Stereotactic radiosurgery (SRS) involves using targeted radiation to treat the area of the brain where seizures start. Other common names for SRS include Gamma Knife and CyberKnife surgery. It is a minimally invasive technique, and no surgical incisions are made in the skin.
Some forms of surgery do not involve removing or changing brain tissue. Rather, they involve implanting devices that can help reduce or manage seizures. Neurostimulation (brain stimulation) device implants include:
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