What is epilepsy surgery?
Epilepsy surgery is a neurosurgical procedure to prevent or reduce the occurrence of epileptic seizures. Epilepsy surgery involves removal or surgical alteration of the part of the brain which is the focal point for onset of seizures.
Epileptic seizures are caused by sudden bursts of abnormal electrical activity in certain brain cells, which may spread to other parts of the brain. Epilepsy surgeries are performed to remove the brain tissue where these electrical signals originate, or disrupt the pathways by which they are transmitted.
How is epilepsy surgery performed?
Surgical procedures vary depending on the type of epilepsy syndrome and the focal point of seizures. A team composed of a neurosurgeon, neurologist, neuropsychologist, neuroradiologist and anesthesiologist are involved in the evaluation of a patient and performance of an epilepsy surgery.
Certain minimally invasive procedures may be performed as outpatient procedures or with short hospital stays. Invasive epilepsy surgeries require general anesthesia and involve varying periods of hospitalization, depending on the type of surgery.
Preparation
An accurate diagnosis of the exact seizure focus area is essential for a successful epilepsy surgery. Prior to the surgery, the patient undergoes several tests which may include:
- Blood and urine tests to assess medical fitness for surgery
- Imaging tests such as:
- Individually tailored neuropsychological testing to assess cognitive functions
- Intracarotid amobarbital (Wada) test to determine which brain hemisphere contains language and memory function
- Electroencephalography (EEG) and long-term video EEG (VEEG) monitoring to obtain data on frequency of seizures and seizure foci, in case there are more than one.
Invasive procedures
All invasive procedures are performed with the patient under general anesthesia.
Prior to the procedure
- The patient is required to
- Avoid eating and drinking for eight hours
- Check with the surgeon before taking any regular medications
- Inform the surgeon of any allergies
- The doctor may
- Reduce or stop antiepileptic drugs.
- Administer antibiotics.
- The patient’s hair on the operative area is shaved and the skin sterilized.
During the procedure,
- The patient lies on their back or turned to one side depending on the type of surgical procedure.
- The anesthetic team administers anesthesia and monitors the patient’s vital functions throughout the procedure and during recovery.
The surgeon
- Makes an incision in the scalp and retracts the scalp
- Cuts out a flap of bone in the skull in a procedure known as craniotomy.
- Opens and retracts the brain’s membrane (dura) to access the brain tissue.
- Performs the required surgical procedure.
- Closes the dura, fixes the flap of bone using surgical glue and sutures the incision close.
In some procedures which can be performed with a smaller opening, the surgeon drills a burr hole in the skull and closes it with sutures in the scalp.
The patient is weaned off anesthesia and monitored for a few hours in the recovery room.
Invasive intracranial monitoring
invasive intracranial monitoring known as electrocorticography (ECOG) may be performed if noninvasive evaluation fails to find a conclusive diagnosis of seizure focus. The surgeon implants electrodes in the brain, guided by continuous X-ray (fluoroscopy).
The electrodes are connected with wires to an EEG device which maps and records seizure activities. The patient may be monitored for two to seven days. Surgery or other therapeutic procedures may follow based on the diagnosis.
Three types of electrodes are used for intracranial monitoring:
- Strip electrodes: Strip electrodes are strips of small metallic disks sheathed in silicon. The surgeon inserts the electrodes through a burr hole and places them on the surface of the brain. The leads from the electrodes are connected to an EEG device.
- Grid electrodes: Grid electrodes are arrays of electrodes which form a grid. Grid electrodes require a craniotomy and the surgeon sutures them to the dura.
- Depth electrodes: Depth electrodes can be inserted through a burr hole and are placed in deep parts of the brain, typically the amygdala or the hippocampus.
Neurostimulation procedures
Neurostimulation procedures involve implantation of electrodes connected to a battery-operated electrical stimulation device, which is also implanted under a flap of skin, typically in the upper chest. The neurostimulator delivers small electric impulses that interrupt electrical communication in the brain and prevent seizures.
The types of neurostimulation include:
- Vagus nerve stimulation (VNS): The electrodes are implanted in the neck adjacent to the vagus nerve and the neurostimulator is implanted in the top of the chest. The wires connecting them are tunneled under the skin.
- Responsive neurostimulation device (RNS): The electrodes are implanted on the surface of the brain’s seizure focus region, and the neurostimulator is implanted under the scalp.
- Deep brain stimulation (DBS): The electrodes are implanted in the hippocampus or amygdala, and the stimulator is implanted in the upper chest.
Invasive surgeries
Invasive epilepsy surgeries involve removal of brain tissue or structural alteration of brain include the following:
- Focal resection: Removal of brain tissue from the largest part of the brain known as cerebrum, consisting of two halves (hemispheres). Each hemisphere contains four sections; frontal, temporal, parietal and occipital lobes. Focal resection may be:
- Anteromedial temporal resection (AMTR): Removal of brain tissue from the anterior temporal lobe, the most common epilepsy origin point.
- Extratemporal resection: Removal of brain tissue from any of the three lobes other than the temporal lobe.
- Lesionectomy: Removal of lesions in the brain tissue.
- Corpus callosotomy: Severing of the corpus callosum, a band of nerve fibers that connects the two cerebral hemispheres.
- Functional hemispherectomy: Removal of a minimal amount of brain tissue from one hemisphere as necessary, and disconnection of its communication with the rest of the brain. In a hemispherectomy an entire hemisphere of the brain is removed.
- Multiple subpial transection (MST): Fine, shallow cuts in the brain tissue to interrupt flow of seizure impulses in parts of the brain which have critical functions such as speech, memory, vision and movement, and are not safe to remove.
Minimally invasive procedures
Some newly developed procedures are minimally invasive, and may be performed as an outpatient procedure or with a very short hospital stay. These include:
- Stereotactic radiosurgery: A procedure which delivers high doses of precisely focused radiation to destroy brain tissue in the seizure focus area.
- Laser interstitial thermal therapy (LITT): A procedure using laser to eliminate seizure-causing brain tissue.
What is the recovery time for epilepsy surgery?
Recovery time depends on the type of surgery performed. With minimally invasive procedures the patient usually can resume normal activities within a day or two. Invasive surgeries may require hospitalization of up to a week, and most patients resume normal activity in six to eight weeks.
Patients must continue taking antiepileptic drugs after surgery, though the doctor may reduce the dosage gradually if the patients remain seizure-free. It may take months for cognitive functions like attention span, memory and thinking to return to normal. Some patients may need therapy if they develop any neurofunctional deficits.
Can surgery cure epilepsy?
All patients may not find relief from seizures after an epilepsy surgery. Surgeries have been found to be effective in preventing seizures in approximately 60% of the patients. Some patients continue to have seizures, but with less frequency and intensity. Some may have no worthwhile benefit.
What are the risks of epilepsy surgery?
Epilepsy surgery is a major procedure involving a vital organ and has risks that any major surgery poses. Risks vary with individuals depending on the area of surgery and underlying conditions. Some difficulties from the surgery are temporary and resolve gradually.
One of the primary risks is lack of relief from seizures. Other risks include:
- Anesthetic side effects such as
- Surgical risks such as
- Hemorrhage
- Wound infection
- Aseptic or bacterial meningitis
- Infection in the operative area
- Injury to brain tissue, blood vessels or nerves
- Leakage of cerebrospinal fluid (CSF)
In addition, procedure-specific complications include the following:
- Strip electrode implantation
- Grid electrode implantation
- Depth electrode implantation
- Intracerebral bleeding (intraparenchymal hemorrhage)
- Bleeding in the space around the brain (subarachnoid hemorrhage)
- Arterial spasm
- Misplacement or displacement of electrodes
- Rarely, permanent neurological deficit
- Focal resection
- Corpus callosotomy
- Hydrocephalus (accumulation of cerebrospinal fluid)
- Frontal lobe cerebral edema
- Excessive blood loss
- Air embolism (blood vessel blockage by a gas or air bubble)
- Venous infarction (tissue death due to obstruction in veins)
- Functional hemispherectomy
- Complications are rare with minimally invasive procedures, but stereotactic radiosurgery and laser interstitial thermal therapies carry risks such as:
- Tissue and nerve damage
- Cerebral bleeding or edema

QUESTION
If you have had a seizure, it means you have epilepsy. See AnswerTop What Are the Risks of Epilepsy Surgery Related Articles
Seizures Quiz
Do you know the difference between seizures and epilepsy? What are the types of seizures? Take the Epilepsy & Seizures Quiz to test your knowledge and learn about this complex disorder of the brain.Epilepsy and Seizures: How to Treat?
A seizure is a sudden, uncontrolled electrical disturbance in the brain. Epilepsy is a neurological disorder where brain activities are abnormal, causing more than one or recurrent episodes of seizures. Most cases of seizures can be managed conservatively with medication and supportive treatments.Epilepsy Slideshow
Learn about epilepsy symptoms and treatment for this seizure condition. Discover the definition of epilepsy, how epilepsy is diagnosed, epilepsy medications, and how epilepsy dogs help people with seizures.gabapentin
Gabapentin is a drug prescribed for the treatment of seizure disorders, nerve damage from shingles and postherptic neuralgia. Off label uses of gabapentin include treatment for substance abuse withdrawal, hiccups, RLS (restless legs syndrome), headaches, diabetic neuropathy, hot flashes, and fibromyalgia, hyperhydrosis. Gabapentin is not an opioid narcotic, but it does have signs and symptoms associated with drug misuse, addiction, and withdrawal symptoms of opioids like sweating, anxiety, muscle pain, insomnia, and goosebumps (philoerections).How Do You Stop Multiple Seizures?
Seizures are a medical emergency. Whether the seizure is a first-time onset or a recurring episode, it is advisable to dial 911 and call for help. A group of drugs called benzodiazepines is usually administered to stop multiple seizures.How Successful Is Surgery for Epilepsy?
Epilepsy surgery is a neurosurgical procedure to prevent or reduce the occurrence of epileptic seizures. Epilepsy surgery involves removal or surgical alteration of the part of the brain from which epileptic seizures originate. Success depends on the condition, procedure and severity of the epileptic condition; epilepsy covers many different seizure disorders.Is CADASIL a Terminal Illness?
Cerebral autosomal dominant arteriopathy with subcortical infarcts and leukoencephalopathy (CADASIL) is a genetic disorder that affects the small arteries in the brain, leading to stroke-like episodes, cognitive decline, and other symptoms. It can be life-threatening in some cases, but symptoms, severity, and progression of the disease varies. The exact mortality rate for people with CADASIL is not known, but a person with CADASIL on average lives for 61 years.lamotrigine, Lamictal, Lamictal CD, Lamictal ODT, Lamictal XR
Lamotrigine (Lamictal) is a drug used in combination with other anti-seizure drugs for the treatment of partial seizures, tonic-clonic seizures of Lennox-Gastaut syndrome. It is also prescribed for individuals over the age of 18 for the prevention of mood episodes in individuals with bipolar disorder. Side effects, drug interactions, warnings and precautions, and pregnancy safety information should be reviewed prior to taking this medication.magnesium sulfate
Magnesium sulfate is a salt of magnesium, a naturally occurring mineral, used to prevent and treat convulsions (seizures) from preeclampsia and eclampsia (toxemia) in pregnant women. Magnesium sulfate is also used to treat certain heart rhythm disorders, magnesium deficiency, and acute kidney inflammation (nephritis) in children. Side effects include flushing, increased sweating, low blood pressure (hypotension), depressed/poor reflexes, flaccid paralysis, low core body temperature (hypothermia), circulatory collapse, depressed cardiac function, central nervous system (CNS) depression, respiratory paralysis, excess fluid in the lungs (pulmonary edema), extreme drowsiness, and others.oxcarbazepine
Oxcarbazepine is an anticonvulsant used in the treatment of partial (focal) onset seizures in both adults and pediatric epileptic patients. Oxcarbazepine may also be used to treat bipolar disorder and nerve pain (neuralgia) and nerve damage (neuropathy) that result from certain neurological diseases. Common side effects of oxcarbazepine include drowsiness (somnolence), dizziness, impaired coordination/balance/speech (ataxia), abnormal gait, tremor, fatigue, headache, vertigo, nausea, vomiting, abdominal pain, diarrhea, constipation, indigestion (dyspepsia), gastritis, loss of appetite (anorexia), dry mouth, rectal hemorrhage, toothache, low sodium levels in blood (hyponatremia), thirst, double vision (diplopia), abnormal vision, repetitive uncontrolled eye movements (nystagmus), abnormal thinking, and others. Consult your doctor if pregnant or breastfeeding.Pediatric Epilepsy Surgery
There are many different brain disorders associated with epilepsy in children including congenital or acquired. There are three types of pediatric epilepsy surgery:- resective epilepsy surgery,
- corpus callosotomy, and
- vagus nerve stimulation.
propofol
Propofol is an intravenous anesthetic drug used for general anesthesia and sedation during surgical procedures. Common side effects of propofol include injection site burning, stinging or pain; low blood pressure (hypotension), reduced cardiac output, elevated blood pressure (hypertension), pause in breathing (apnea), lung impairment (respiratory acidosis), impaired movement, high level of emulsified fats in the blood (hyperlipidemia), and high triglyceride level in blood (hypertriglyceridemia). Abuse of propofol can cause death and other injuries.succinylcholine
Succinylcholine is a skeletal muscle relaxant used for medical procedures done under general anesthesia, including tracheal intubation, mechanical ventilation, and surgeries. Common side effects of succinylcholine include postoperative muscle pain, jaw rigidity, muscle twitch (fasciculation), respiratory depression, cessation of breathing (apnea), low or high blood pressure (hypotension or hypertension), irregular heart rhythms (cardiac arrhythmias), slow or rapid heartbeat (bradycardia or tachycardia), cardiac arrest, increase in intraocular pressure (IOP), high blood potassium levels (hyperkalemia), severe life-threatening drug reaction with excessively high temperature (malignant hyperthermia), salivary gland enlargement, excessive salivation, rash, hypersensitivity reactions, and others.Surgical Options for Epilepsy
Epilepsy is mostly treatable with medication, but this method is not effective for about 30% of patients. In some cases, brain surgery may be an option. Epilepsy surgery is an operation on the brain to control seizures and improve the person's quality of life.Vimpat
Lacosamide is a prescription medicine used to treat partial-onset seizures in people 4 years of age and older. This epilepsy drug may cause suicidal thoughts and is also potentially addictive. Vimpat is a federally controlled substance (CV) because it can be abused or lead to drug dependence. The most common side effects of Vimpat in adults include double vision, headache, dizziness, and nausea. Serious side effects of Vimpat include a serious allergic reaction.Can a Person With Epilepsy Live a Normal Life?
Can a person with epilepsy live a normal life? What is epilepsy and what causes it? Learn the signs and symptoms of epilepsy, what causes it, how doctors diagnose it, and what you can do to treat it.What Are the Side Effects of Antiepileptic Drugs?
Antiepileptic drugs (AED) are medications given to control epileptic seizures and convulsions. Antiepileptic drugs do not cure epilepsy, but may reduce the frequency, duration, and severity of seizures. Most people must continue taking antiepileptic drugs for their entire lives. Side effects vary depending on the seizure medication. The first-generation antiepileptic drugs can have severe side effects and are known to cause liver damage. Some antiepileptic drugs may also interact with others.