Epilepsy Surgery

What Is Epilepsy Surgery?

Epilepsy surgery is an operation done on the brain to reduce or stop seizures. The surgery is considered when a child's seizures aren't controlled by medicine or other treatments (called intractable epilepsy). The surgery is designed to stop all the seizures or, at least, make them happen less often.

Children best suited for epilepsy surgery typically have seizures that come from one area in the brain, which a surgeon can remove or separate without causing any permanent or significant neurological problems.

After surgery, some kids can stop taking their seizure medicine, but most just take less of it.

What Are the Kinds of Epilepsy Surgery?

Epilepsy surgeries include resective surgery and corpus callostomy.

Resective Surgery

In resective surgery, doctors take out the area of the brain causing the seizures. Sometimes, this is only a small piece of brain; other times, a larger part is removed. Resective surgery can be a:

• lesionectomy: This is done in the one area found to be the cause of the seizures.
• lobectomy: This affects bigger areas of the brain, such as the temporal lobe or frontal lobe.
• hemispherectomy: When an entire side ("hemisphere") of the brain causes the seizures, the surgical plan involves “quieting” that side so it can't cause seizures. This surgery can be:
  • an anatomic hemispherectomy: The surgeon removes the entire hemisphere of concern.
  • a functional hemispherectomy: The surgeon disconnects the two sides and removes only small parts of brain in the affected side.

Corpus Callostomy

In corpus callostomy, the corpus callosum (keh-LOW-sem) is cut. The corpus callosum is a bundle of nerve fibers that connects the two sides of the brain, letting them communicate with each other. If it's cut, a seizure that starts on one side of the brain can't spread to the other side. Often, this won't completely stop all seizures, but they'll happen less often, improving a child’s quality of life.

What Happens Before Epilepsy Surgery?

A neurologist who specializes in epilepsy (an epileptologist) does tests to find the area in the brain where the seizures begin. Then, a team of medical specialists meets to talk about how to do the surgery. They include:

• epileptologists and neurologists
• neurosurgeons (doctors who do surgery on the brain and spinal cord)
• neuropsychologists (health care providers who focus on how the brain affects our thoughts and actions)
• neuroradiologist (doctors who specialize in interpreting brain imaging studies)

The doctors may order tests, such as:

• CAT scan, MRI, and PET/MRI to look at the brain
• EEG to see where in the brain the seizures are happening

They might also do these tests to see what part of the brain controls activities such as speech, memory, and vision:

• Wada test: Medicine injected into the bloodstream puts one side of the brain briefly “to sleep.” Then the doctor does speech and memory tests to see what part of the brain is used. 
• functional MRI (fMRI): As the patient follows instructions, the MRI shows a change in blood flow in the area of the brain being used. Often, it can identify the parts of the brain controlling movements (motor cortex), sensation (sensory cortex), and speech and language (language area).
• neuropsychology test: A neuropsychologist does tests to see how each part of the brain works.
• electrical brain mapping: Electrodes placed on or inside the brain stimulate some areas to show which activities they control.

What Is intracranial EEG Monitoring?

As they plan for epilepsy surgery, the team may decide a child needs intracranial EEG monitoring, which lets them see more clearly where the seizures come from. They'll place electrodes directly inside the brain while a child is under general anesthesia. This lets the epileptologist map the brain and identify the parts responsible for important jobs like controlling movement and language processing.

The two main ways to do intracranial EEG monitoring are:

• stereo-EEG or depth electrodes: The neurosurgeon will drill several small holes to place the electrodes into the brain. They might use a robotic arm to help do this procedure.
• grid and/or strips: The neurosurgeon will remove a part of the skull (called a craniotomy) and place the electrodes directly over the brain.

What Happens During Epilepsy Surgery?

A child will get general anesthesia to sleep through the surgery and not feel pain. Hair in the surgical area might be shaved to lower the chances of infection.

The neurosurgeon will do a craniotomy to expose the brain. Depending on the type of surgery, the surgeon will either remove part of the brain or cut the corpus callosum. Then, the skull bone is put back so it can heal.

Most open epilepsy surgeries last several hours.

What Happens After Epilepsy Surgery?

After epilepsy surgery, your child will go to a special recovery area called a PACU (post-anesthesia care unit) for a few hours until the anesthesia wears off.

Depending on the surgery, your child may spend the first night in a special intensive care unit, then move to a neurosurgical unit for the rest of the stay.

Most children go home 3–4 days after the surgery, depending on which procedure was done. It can take at least 3–4 weeks to recover fully from epilepsy surgery.

Are There Any Risks From Epilepsy Surgery?

Possible risks of epilepsy surgery include infection, bleeding, brain swelling, or complications from anesthesia.

Other risks depend on the type of surgery. These include increased seizures or changes in speech, vision, memory, language, or movement. The epileptologist and neurosurgeon will talk to you about your child's specific surgery.

How Can Parents Help?

Help prepare your child for surgery. Kids of all ages cope much better if they have an idea of what's going to happen and why.

Use simple, calming words to explain the reason for the surgery. Talk about the medical problem and why surgery is necessary. Depending on your child's age, you can talk a bit about the surgery and the recovery period. Your doctor can recommend age-appropriate books, articles, and other resources that can help.

After the surgery, your child will be sleepy and need rest. You can help by limiting visitors and visiting hours.

Your child will need medical follow-up and may need physical therapy, occupational therapy, or speech-language therapy after leaving the hospital. Schedule all follow-up visits as recommended by the doctor.

When Should I Call the Doctor?

At home, your child will need care as they heal.

Call the doctor right away if your child has:

• a fever above 101°F (38.3°C)
• swelling or redness at the incision site
• fluid leaking from the incision
• severe headaches
• nausea or vomiting