Epilepsy Surgery Procedure
Overview
Epilepsy surgery aims to control seizures and support better daily living for those with epilepsy. Doctors usually consider this treatment after at least two different seizure medicines have failed.
Surgery often works best when seizures begin in one clearly identified area of the brain. Before any procedure, doctors conduct different tests to see if patients qualify and to choose the best surgery option.
Key points about epilepsy surgery:
- Not the first treatment choice
- Helps reduce or stop seizures
- Needs detailed testing before surgery
- Most helpful for focused seizure areas
Reasons for Considering Surgery
Doctors use epilepsy surgery for people whose seizures cannot be controlled with medicine alone, a condition known as drug-resistant or intractable epilepsy. These surgeries aim to reduce the number or intensity of seizures and improve quality of life, especially when ongoing seizures cause serious risks.
Types of epilepsy that surgery may help include focal onset epilepsy, where seizures begin in one area of the brain. Children and adults with medically refractory epilepsy often become candidates, especially when seizures cause injuries, learning problems, or increase the risk of accidents such as drowning or falls.
| Surgery Type | Description | Who May Benefit |
|---|---|---|
| Resective Surgery | Removing a specific part of the brain where seizures start. | People with seizures in a single brain region |
| Laser Interstitial Thermal Therapy | Using a laser to destroy seizure-causing tissue guided by MRI. | Those seeking a less invasive surgery |
| Deep Brain Stimulation | Electrodes implanted in the brain send electrical pulses to interrupt abnormal activity. | Individuals not suitable for tissue removal |
| Corpus Callosotomy | Cutting nerve fibers between the two halves of the brain to stop the spread of seizure activity. | Children with seizures affecting both brain sides |
| Hemispherectomy | Removing one half of the brain’s cortex, often for severe cases in young children. | Children with seizures from one hemisphere |
| Functional Hemispherectomy | Disconnects brain regions instead of removing them, often used in children. | Children with seizures in one hemisphere |
Benefits and Risks
Benefits:
- Fewer or no seizures.
- Possible reduction or stopping of antiseizure medicines over time.
- Lowered risk of physical injuries and accident-related deaths.
- May lead to better thinking skills, mood, and development in children.
Risks and reasons for careful consideration:
- Not all types of seizures or epilepsy are suitable for surgery.
- Surgery has risks such as infection, neurological changes, or continued seizures.
- People need to continue medication use for some time after surgery, and results vary depending on the type and severity of epilepsy.
Common complications of uncontrolled epilepsy:
- Physical harm during a seizure.
- Emotional challenges, including depression or anxiety.
- Problems with memory, learning, or attention.
- Rarely, sudden unexpected death due to seizure complications.
Below is a list to help evaluate surgery as an option:
- Has medication failed to stop or control seizures?
- Are seizures causing injuries or posing safety risks?
- Has epilepsy limited daily life, learning, or social development?
- Has the source of seizures been located in a particular part of the brain?
A team of neurologists and surgeons makes surgical decisions after conducting careful tests, including MRI scans and brain activity monitoring, before any procedure.
Possible Complications
Epilepsy surgery carries several risks, and these depend on the part of the brain involved and the exact procedure. Some people may experience issues such as trouble with memory or trouble finding the right words, which can make talking or understanding others harder. Other complications include changes in vision, mood problems like depression, or headaches.
| Risk | Description |
|---|---|
| Memory problems | Difficulty recalling information |
| Language issues | Trouble speaking or understanding |
| Vision changes | Overlapping or loss of vision areas |
| Mood changes | Depression or mood swings |
| Headache | Pain in the head after surgery |
| Stroke | Higher risk of reduced blood flow to brain |
| Infection | Increased chance of infection after surgery |
Getting Ready for Surgery
Locating Where Seizures Start
A team of specialists, including neurologists, neurosurgeons, and often an epileptologist, works together to find the part of the brain where seizures begin. This process involves several tests and monitoring procedures. Common tests include:
- Standard EEG: Doctors place small electrodes on the scalp to measure the brain’s electrical signals, capturing what happens when the person is not having a seizure. This can show general areas that could be causing seizures.
- Video EEG Monitoring: For this, doctors admit patients to an epilepsy monitoring unit (EMU). The EEG tracks brain waves continuously, while a camera records the person’s movements. Doctors might reduce or stop medicine to let seizures happen. By comparing brain signals with body movements, specialists look for patterns and locate the seizure focus.
- MRI Scan: Magnetic resonance imaging (MRI) takes clear brain pictures using strong magnets and radio waves. It helps detect damaged tissue or growths that may be linked to seizures.
If these standard tests are not enough, doctors use other specialized methods:
- Invasive EEG Monitoring: Some people need electrodes placed directly on or in the brain. Surgeons use grids, strips, or depth electrodes to record activity more accurately. This can mean a small opening in the skull, and the patient stays in the hospital for careful monitoring.
- Combined Video and Invasive EEG: In some cases, doctors use invasive electrodes during prolonged video EEG monitoring. This allows for even more detailed information about seizure origins.
- PET Scan: Positron emission tomography (PET) shows how well areas of the brain are working. Doctors perform the scan while the person is not having a seizure and can merge the results with MRI for detailed analysis.
- SPECT Scan: Single-photon emission computerized tomography (SPECT) shows blood flow patterns in the brain during a seizure. The area with higher blood flow can point to where seizures start. Doctors also perform this test during a hospital stay.
Summary Table: Seizure Source Tests
| Test Type | What It Measures | How It’s Done | Who Performs It |
|---|---|---|---|
| EEG | Brain electrical activity | Scalp electrodes | Neurologist, Technologist |
| Video EEG | Brain and body during seizures | Continuous EEG & video in EMU | Epileptologist, Technologist |
| MRI | Brain images | Imaging (no radiation) | Radiologist, Neurologist |
| Invasive EEG | Deeper brain signals | Surgically placed electrodes | Neurosurgeon, Team |
| PET | Brain function | Imaging after tracer injection | Radiologist, Neurologist |
| SPECT | Brain blood flow | Imaging during seizure | Radiologist, Neurologist |
Checking Brain’s Critical Functions
After doctors find the likely seizure focus, they need to learn more about nearby brain areas. Protecting key brain functions is a main priority in planning the surgery. The care team uses tests to find out which parts control important tasks, such as speaking, moving, or feeling sensation.
Main Tests Used
- Functional MRI (fMRI): Doctors ask the person to do activities, like talking or looking at pictures, while the MRI records which areas are active. This points out places responsible for movement, language, and vision.
- Wada Test: Sometimes called an intracarotid amobarbital procedure, this test puts one side of the brain “to sleep” for a short period. Doctors inject medicine into one artery at a time and check memory and language skills. This shows which side handles these abilities. Though fMRI is now more common, the Wada test is still used in special cases.
- Brain Mapping: Doctors place electrodes directly on the brain’s surface during surgery. The patient stays awake to answer questions or follow simple tasks. The team checks how the brain responds, matching each task to areas tested by the electrodes. This information helps avoid injury to important regions.
- Magnetoencephalography (MEG): MEG detects magnetic currents from brain cells as the person does simple activities. Doctors use this test with MRI or EEG data for more detail about brain function.
Key Steps in Function Tests
- Identify important brain regions (like those tied to speech or movement).
- Use safe, noninvasive tests first.
- If needed, use more invasive tests for high accuracy.
- Work closely with neurosurgeons and neuropsychologists for test results.
Cognitive and Memory Testing
Neuropsychologists conduct neuropsychological tests as a critical part of pre-surgery evaluation. These tests focus on how well a person learns, remembers, and solves problems. The tests check for both verbal (using words) and nonverbal (using images or patterns) thinking skills. Some areas neuropsychologists assess include:
- Attention
- Short and long-term memory
- Problem-solving
- Reasoning skills
- Processing speed
- Language abilities
- Visual and spatial understanding
Neuropsychologists usually conduct these tests in a quiet setting, separate from other hospital procedures. They may ask patients to answer questions, do puzzles, or draw pictures. The results help the care team:
- Match memory and thinking skills to areas seen in MRI or EEG tests.
- Predict how surgery might affect the person’s ability to speak, remember, or think.
- Compare abilities before and after surgery for follow-up care.
List of Medical Staff Involved
- Neurologist
- Epileptologist
- Neurosurgeon
- Neuropsychologist
- Radiologist
- EEG Technologist
What to Expect with Epilepsy Surgery
Preparation Steps Before Surgery
Before the surgical procedure, the medical team trims or shaves the hair over the area of the skull where the operation will take place. This lowers the risk of infection. Staff insert an intravenous (IV) line for fluids, anesthesia, and other necessary medications. A checklist ensures safety and readiness:
| Preparation Steps | Purpose |
|---|---|
| Hair clipped or shaved | Prevents infection |
| IV line inserted | Delivers fluids and medications |
| Pre-surgery monitoring | Checks vital signs |
Steps Taken During the Surgery
During the actual surgery, staff closely track the patient’s heart rate, blood pressure, and oxygen levels. Sometimes, specialists use an EEG to monitor brain activity, which helps pinpoint the areas causing seizures.
Most epilepsy surgeries use general anesthesia to keep the patient asleep and pain-free. For some procedures, especially when mapping areas controlling speech or movement, doctors may awaken the patient briefly but keep them comfortable with strong pain medicine.
The surgeon creates a small opening in the skull, known as a craniotomy, to reach the target area. After the procedure, the surgeon replaces and secures this window in the bone. Common types of epilepsy surgeries include focal resection, temporal lobectomy, lobectomy, and minimally invasive techniques such as laser interstitial thermal therapy.
Recovery and Healing After the Procedure
After surgery, staff move patients to a recovery area for observation. Some patients spend the first night in an intensive care unit. Most people stay in the hospital for three to four days.
Head swelling and discomfort often occur after surgery. Staff use pain relief medicine and ice packs to manage these symptoms in the first several days. Problems such as memory changes or mild vision issues can occur, depending on the surgery type.
Returning to work or school usually takes one to three months. Rest is important at first, followed by a gradual increase in activity. Rehabilitation services support those who may face challenges with thinking or other brain functions, helping ensure a smoother recovery.
Surgical Outcomes
The effectiveness of epilepsy surgery depends on the procedure and patient factors. Temporal lobe resection is the most common approach and provides seizure freedom for about 67% of patients.
The chances of long-term control increase if no seizures occur within the first year after surgery. Key seizure freedom rates after temporal lobe surgery:
| Time After Surgery | Seizure-Free Rate |
|---|---|
| 2 years | 87–90% |
| 5 years | 95% |
| 10 years | 82% |
People who remain seizure-free for one year may gradually reduce their anti-epileptic medications, and some eventually stop taking them. If seizures return, restarting medication usually controls them.
Neurostimulation devices such as responsive neurostimulation (RNS) and deep brain stimulation offer options for those who do not achieve full seizure control with surgery alone. These treatments, along with therapy and medication management, can reduce seizures and improve daily functioning and quality of life.
