what are the surgical options for epilepsy?

Different surgeries are available for different types of epilepsy.

Focal Resection

This type of surgery removes the part of the brain that is causing the seizures. This is the most common type of epilepsy surgery. It is an excellent option for children who have seizures that occur in one area of the brain. Since this surgery involves removing part of the brain, it is usually used for non critical brain regions that do not control speech, movement, memory and vision.

Temporal Lobe Resection

A temporal lobe resection removes a portion of the temporal lobe of the brain. The temporal lobe is one of the four major lobes in the brain.It is the lower lobe of the brain and sits close to ear level. The temporal lobe is responsible for creating and preserving both conscious and long-term memory.  Many will still need to take anti-seizure medications. Over time with the help of their epilepsy team, children are often able to lower their dose of medication.

Frontal Lobe Resection

A frontal lobe resection removes an area of the frontal lobe where the seizures begin. The frontal lobe is the part of the brain that controls functions, such as motivation, attention, concentration, organization, planning, mood and impulse control. Children who have frontal lobe seizures may have problems with these functions before surgery.  Most will need to continue taking anti-seizure medications. Overtime, with the help of their epilepsy team, they are often able to lower the dose.

Parietal and Occipital Lobe Resection

The parietal and occipital lobes are located in the back part of your brain. A parietal or occipital lobe reaection is surgery to remove part of or one of these lobes. This type of surgery is usually performed when an area in these lobes contains an abnormal structure or a lesion.

Lesionectomy

This operation involves removing the lesion and the area surrounding brain tissue that is causing seizures. Children with a well-definted structural abnormality in the brain causing their seizures, such as a tumor or vascular malformation, may be considered for this type of surgery.

Multiple Subpial Transections (MST)

When a child has seizures that begin in a part of the brain that cannot be removed safely, multiple subpial resections are used. This includes areas of the brain that control speech or movement.

During this surgical procedure a neurosurgeon opens the skull and makes a series of fine shallow cuts (transections) into the brain. The cuts work by interrupting fibers that are thought to be involved in the spread of electrical seizure activity.

Sometimes multiple subpial transections are done in combination with a surgical resection. Thus happens when part of the seizure focus is in a critical region of the brain and a complete resection is not possible.

Anatomical of Functional Hemispherectomy and Hemispherotomy

These types of epilepsy surgeries are almost exclusively performed in children with seizures coming from a large area on one side of the brain. The procedures involve separating the area of the seizure onset from the rest of the brain.

The results of these surgical procedures are very good.

Corpus Callostomy

Corpus callosotomy is often performed in people with severe generalized epilepsy (meaning seizures involve both sides of the brain) who are subject to drop attacks and falls. The procedure focuses on splitting the main connection pathway between the two sides of the brain.

Children being considered for this operation have:

• Frequent tonic, atonic, atypical absence, or tonic-clonic seizures
• Developmental delay
• Disabling seizure-related falls

Implantation of Vagus Nerve Stimulator (VNS)

VNS is approved for treatment of focal epilepsy when surgery is not possible or does not work. A small electrical generator is implanted under the skin over the chest. A wire, called a "stimulator lead," is then attached onto the vagus nerve located in the neck. The generator is placed on a set schedule to stimulate the vagus nerve. Over time this helps to reduce the number or severity of seizures a child has.

how can I decide if surgery is the right choice for my child?

Epilepsy surgery might be a good option for you child if they are experiencing one or more of the following situations:

• Your child has tried two or more anti-seizure medications but still has seizures
• Your child's seizures affect their day-to-day life
• Your child has drug-resistant focal epilepsy, which means their seizures always start in the same region of the brain
• An MRI (magnetic resonance imaging or brain scan) shows an abnormality in an area of the brain where seizures are also known to start

how many stages of surgery will my child have?

Some children are able to have a surgical resection completed in one stage or procedure. While others may need to undergo 2 stages or procedures.

If a second stage of surgery is needed, the first stage will be used to locate where seizures are coming from. This is done by using electrode grids or strips or with implanted depth or stereoelectrodes (also called Stereo-EEG or SEEG).

using grids or strips

• The neurosurgeon will perform a craniotomy to place the grid or strips on the surface of the brain.
• Your child will stay in the hospital and wires will be attached to the grid or strips. These wires will connect to an EEG (electroencephalograph) to capture where seizures take place.
• Days after a grid is placed, your child may have swelling and bruising on their face and head close to where the grids are placed. Your child will be watched closely by their care team for fluid collection or bleeding around the grids. You child may also experience headaches and nausea during this stage.
• After enough information has been collected, you child will have another surgery to remove the grid and remove the area of the brain where seizures start.

using stereoelectrodes or depth electrodes

• Stereoelectrodes or depth electrodes are implanted by a neurosurgeon.
• You child will stay in the hospital for 1-2 weeks and wires will be connected from the electrodes to an EEG to find where their seizures are starting.
• After the electrodes are placed it is common for your child to have a headache or mild nausea for 1-3 days. These side effects are treated with medications.
• Once enough information has been collected, the stereoelectrodes are removed under anesthesia in a procedure that usually takes less than 1 hour.
• Your child will be able to go home after the recover from the electrodes being removed. This usually happens the next day.
• If your child needs to have resective surgery, they will return to the hospital 4-8 weeks later for that surgery. This time between surgeries allows your child's incision to heal and decreases the risk of infection.

how will my child be monitored during the surgery?

• Your child's anesthesiology team will monitor your child's breathing, heart rate, blood pressure, oxygen levels and comfort throughout the surgery.
• General anesthesia is used during brain surgery. This will require the placement of a breathing tube.
• Sometimes more brain monitoring is needed during surgery. This could include electrocorticography to help guide the removal of the seizure focus. It could also include motor and sensory monitoring to make sure those areas of the brain are protected.

will my child be seizure free after surgery?

Epilepsy surgery is not a guarantee that a child will be seizure-free. Your child's individual change of seizure freedom should be discussed with your epilepsy surgery team before surgery.