Surgery for Epilepsy

Surgery for Epilepsy

Surgery may be done to remove the part of the brain where the seizures are occurring or to help stop the spread of the abnormal electrical currents through the brain. Surgery may be an option if your child’s seizures are hard to control and always start in one part of the brain that doesn’t affect speech, memory or vision.

Surgery for epilepsy seizures is very complex. It is done by a specialized surgical team. Your child may be awake during the surgery. The brain itself does not feel pain. If your child is awake and able to follow commands, the surgeons are better able to check areas of his or her brain during the procedure. Surgery is not an option for everyone with seizures.
Surgical treatment options include:

Corpus callosotomy

The corpus callosum is a part of the brain that mediates communication between the left and right hemispheres. Severing part or all of the corpus callosum can reduce the spread of seizures and the frequency of drop seizures. Other seizure types may also be reduced by this procedure.

Hemispherectomy

This surgical procedure is used to treat patients with intractable epilepsy associated with an abnormal hemisphere of the brain. It is almost exclusively performed in children because their brains generally reorganize, allowing brain cells from the remaining hemisphere to take over the tasks from the lost hemisphere. In one study of children under age 5 who had this surgery, 73.7 percent were freed of all seizures.

Laser ablation

Known as MRI-guided laser-induced thermal therapy (LITT), this procedure is used to destroy small brain lesions. Most patients have little or no hair removed and minimal sutures are required, sometimes just one stitch.

Lesional and non-lesional brain resections

Some children with intractable epilepsy are born with brain malformations or slow-growing, benign tumors that should be removed. Children whose intractable epilepsy is caused by brain lesions may be freed of all seizures by removing these lesions.

Lobectomy

Each brain hemisphere has four lobes, or areas in the brain. A lobectomy is the removal or disconnection of an entire lobe or part of a lobe that is producing seizures. Most lobectomies done in children are extratemporal (outside the temporal lobe).

Vagus nerve stimulation (VNS)

 
Vagus nerve stimulation (VNS) sends small pulses of energy to the brain from one of the vagus nerves, a pair of large nerves in the neck. If your child is age 12 or older and has partial seizures that are not controlled well with medication, VNS may be an option.
 
The procedure involves placing a small battery into the chest wall. Small wires are attached to the battery and placed under the skin and around one of the vagus nerves. The battery is programmed to send energy impulses every few minutes to the brain. When your child feels a seizure coming on, he or she may activate the impulses by holding a small magnet over the battery. In many cases, this can help stop the seizure.