Pediatric Epilepsy Surgery (cont.)

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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).

  1. In resective surgery the part of the brain that causes the seizures is removed.
  2. In corpus callosotomy the major connection between the two sides of the brain is severed (cut).
  3. 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.

Medically Reviewed by a Doctor on 2/25/2014


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