Epilepsy surgery is a surgery performed to either remove a part of the brain where seizures originate or place a special device capable of sending electrical stimulation to areas of the brain where seizures originate. While epilepsy surgery is not always the first line of treatment, it may be an option for patients whose seizures have been otherwise unresponsive to medication. Surgery is typically successful for patients whose seizure activity occurs in a focused area of the brain; however, there are also surgical options available to treat more complex or diffuse seizures.
If your seizures have been unresponsive to medication, also known as drug-resistant epilepsy, you may be a candidate for epilepsy surgery. Epilepsy surgery may also be an option if your seizures are triggered by a lesion, such as a brain tumor or scar tissue.
In some specific instances, special wires may be placed within the brain and kept in for 1-2 weeks in order to determine where seizure activity originates. This procedure is called stereo EEG. Depending on the results of the stereo EEG, these results are used to guide further surgical treatment options.
There are various types of epilepsy surgery used to eliminate or reduce seizures. You and your neurosurgeon will determine the best treatment option based on your needs including your age, the location of your seizures, and other patient specific factors.
- Deep brain stimulation (DBS) – DBS surgery uses MRI-guided technology to deliver electrodes to targeted areas of the brain with pinpoint accuracy. The electrodes propagate electrical signals capable of reducing and/or eliminating seizure activity.
- Laser interstitial thermal therapy (LITT) or laser ablation – a minimally invasive procedure that involves placing a special laser fiber through a small incision to areas of the brain where seizures generate LITT uses MRI guidance to ensure accuracy prior to using laser thermal energy to create a lesion in the part of the brain causing seizures.
- Resective surgery – one of the most common procedures used to treat epilepsy, resective surgery removes a portion of the brain where seizures occur. If a lesion is present, this typically involves removing the lesion responsible for seizure generation. A lesion does not always need to be present for resective surgery to be performed.
- Temporal lobectomy – This surgery involves removing a portion of the temporal lobe responsible for seizure activity
- Selective amygdalohippocampectomy – If seizures are found to be originating only within the hippocampus and amygdala (mesial temporal lobe epilepsy), this surgery involves removal only those mesial structures while preserving the rest of the temporal lobe.
- Corpus callosotomy – This procedure is typically performed only in patients with severe drop attack seizures. It involves removing the corpus callosum which connects the right and left hemispheres of the brain.
- Responsive neuro-stimulation (RNS) – An implantable device that utilizes special electrodes located within specific areas of the brain where a patient’s seizures are thought to originate. Then, as a seizure occurs, the device detects seizure activity and sends an electrical impulse directly into the region of the brain responsible for the seizure activity in order to terminate the seizure.
- Vagus nerve stimulation (VNS) – disrupts electrical signals causing seizures by sending periodic electric impulses to the vagus nerve via a special implanted electrode within the neck which attaches to a battery located under the skin overlying the chest. This procedure is typically reserved for patients whose epilepsy is more diffuse whereby resective surgery is not possible.
Before the procedure, your neurosurgeon will explain the surgery with you, along with the risks and benefits. This will be the time to ask any questions you might have and talk through any medications you are taking that may need to be modified on the day of the surgery. You must not take any non-steroidal anti-inflammatory medicines (ibuprofen) or blood thinners seven days prior to surgery. You must also stop the use of nicotine and alcohol 1 week before and 2 weeks after surgery to avoid any complications in your recovery.
Tests, like blood work, an electrocardiogram and chest X-ray may be requested prior to your surgery. Avoid eating or drinking after midnight the day before your surgery.
On the day of your surgery, wash your hair and skin with Dial soap to kill bacteria and reduce infection. Dress in clean, loosely fitted clothes, and avoid wearing makeup or jewelry.
Your care team will cut short or shave the section of the head that will be operated on in order to avoid infection, and an IV will be placed to deliver fluids and other medications throughout the procedure.
Epilepsy surgery is typically performed under general anesthesia. However, in some instances the surgery may be done under sedation to determine the parts of the brain controlling language and movement. In these circumstances, additional anesthesia is administered to avoid feeling any pain.
You will be closely monitored as you wake up from the anesthesia. Narcotics are typically administered for the first few days of hospital stay after epilepsy surgery.
Postoperative pain and swelling will improve within a few weeks.
You may not be able to return to work or school for approximately one to three months. You should rest and relax the first few weeks after your surgery and then gradually increase your activity level.
Postoperative pain and swelling will improve within a few weeks. The first few weeks after surgery, it is essential to your recovery to rest, and then increase your activity level gradually.
You will not need intensive rehabilitation if the surgery was completed without complications such as stroke or loss of speech.
Risks vary for epilepsy surgery depending on the location of your seizures and the type of surgery. This is because different parts of the brain are responsible for different functions. Your care team will help you understand your specific risks, and the best treatment plan to reduce any potential complications. Potential risks may include:
- Depression or mood changes
- Language and memory problems affecting your ability to process and communicate language
- Nerve damage
- Visual impairment
Results for epilepsy surgery vary depending on where your seizures are located and what’s causing them. Some types of epilepsy have almost a 90 percent chance of being seizure free after the procedure. For others, the goal is to reduce the number of seizures rather than eradicate them altogether. It’s important to talk to your doctor to evaluate the risks and benefits to epilepsy surgery based on your individual needs.