Treatment Options: Surgery

When should brain surgery be considered?

The road to brain surgery is not a simple one. It relies on consistent and honest communication between the patient, the neurologist or epileptologist and the rest of their care team, if they have one.  Your team will work with you over time to ensure all possible aspects that may affect the efficacy of your overall seizure treatment have been looked into. 

Epilepsy surgery may be considered when one or more of the following circumstances is present:

  • The person has tried two or more anti-seizure medications and is unable to achieve seizure control.
  • The person’s seizures are disabling, affect day-to-day life, and reduce their quality of life.
  • The person has drug-resistant focalized epilepsy, which means their seizures always start in the same region.
  • A brain scan shows an abnormality in an area of the brain where seizures are also known to start.
  • Certain people with uncontrolled generalized epilepsy who have atonic seizures and tonic seizures may benefit from surgery.
  • The person has seizures that cause increased risk for injury, status epilepticus (when seizures last longer than 5 minutes or occur close together without recovery), or SUDEP.

Surgical Evaluation

The surgical evaluation process may vary from patient to patient depending on what type of seizures they have, what type of surgery is being looked at and what specific risks vs. benefits are present in each individualized case.

The first phase typically takes place outpatient but depending on past testing and current needs, may include a brief hospital stay.  During this process, the care team will work to determine many variables that will impact the action of surgery.  This will include numerous tests that can include:

  • EEG
  • Video EEG Monitoring
  • CT Scan
  • MRI and/or PET Scan
  • Neuropsychology Testing
  • And many more…

In addition to testing, the team will also work towards identifying and assessing the following:

  • Current Neurologic Status
  • Drug Resistant Seizures
  • Emotional or Behavioral health concerns
  • Past treatments
  • Presence of a lesion or other structural abnormality
  • Quality of Life
  • And many more…

Additional, more in depth testing, may be needed and will be determined on a case by case basis.

Types of Surgery:

There are various types of surgery that are available to treat uncontrolled seizures.  The determination of what surgical option is best for each patient varies on many factors.  Below is a small list of the common options.

  • Focal Resection: Surgery that removes the area of the brain causing seizures.
  • Lesionectomy: Removal of a lesion in which cause focal seizures.
  • Laser Interstitial Thermal Therapy or Laser Ablation Surgery: Laser is used with immense accuracy to remove the seizure focus with the assistance of an MRI to guide to identified area.
  • Anatomical or Functional Hemispherectomy: Surgery separates the seizure focus area with the rest of the brain.  This option is for youth with larger areas of seizure focus.
  • Corpus Callosotomy: The splitting the main connection between both hemispheres.  This option is reserved for patients with severe generalized epilepsy.

For all questions regarding brain surgery as a treatment option, please speak with your neurologist or epileptologist.