Pediatric Epilepsy Surgery (cont.)
Who performs pediatric epilepsy surgery?
The actual surgery is performed by a neurosurgeon with
specialized training and experience in pediatric epilepsy surgery. However,
prior to the surgery the patient must be evaluated by a team of epileptologists,
neuroradiologists, neuropsychologists, and neurosurgeons with specialized
training in patients with refractory epilepsy. Most of these teams are in large academic medical centers
with affiliations to medical schools. The team will tailor the surgery for each
child on an individual basis.
What are the types of epilepsy surgery?
The following are the surgical interventions that are
performed to control epileptic disorders. These procedures can be done directly
on the brain, (resective surgery or corpus callosotomy), or by implanting a
stimulator of the vagus nerve in the neck (vagal nerve stimulation).
- In resective surgery the part of the brain that causes the seizures is
removed.
- In corpus callosotomy the major connection between the two sides of the brain
is severed (cut).
- Vagus nerve stimulation is a procedure in which a small wire is attached to
the vagus nerve in the neck. This wire is used to electrically stimulate the
vagus nerve.
Resective epilepsy surgery
Resective surgery is the best indication for those children with epilepsy
that is resistant to the antiepileptic medications and in whom a focal area of
the brain was identified as the cause of the seizures. Most of these children
have focal seizures rather than generalized seizures. In this procedure, the
portion of the child's cerebral cortex that is causing seizures is removed. In
some children the epileptic area is restricted to one discrete area of the
brain, for example the temporal lobe; in other children several areas of the
brain might be involved. The type and the extent of the surgery depends upon the
size and location of the epileptogenic area. When the lesion is very discrete, a
small area of the brain might be removed, a procedure known as partial
lobectomy. If the lesion is more extensive, the child might need a bigger
resection, known as multilobar resection. In some extreme cases a full half of
the brain might need to be removed, known as a hemispherectomy.
Since resective surgery will result in the elimination of an area of the
brain that might still be functioning before the operation is performed, it must
be determined that the area in question can be removed without unacceptable
problems, such as a loss of language capacity or a severe motor (movement)
insufficiency.
In some children resective surgery could be the most
effective form of treatment. For example, in children with mesial temporal
sclerosis, a condition
in which there is a well-localized lesion in the temporal lobe, the resection of
the lesion can result in up to 80% of patients being seizure-free. Fifty percent
of children with extensive malformations involving one hemisphere may be
seizure-free after hemispherectomy.
In general, for the selective group of children with well-localized lesions,
resective surgery will be beneficial in most of them.
Next: Corpus callosotomy »
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