What are the different types of epilepsy surgery?

Aria Fallah, MD
There are several different types of surgical treatment for epilepsy.
These include resective surgery, operations that are generally designed to cure the epilepsy. In resective surgery the surgeon removes the area of brain that causes the seizures. This can include large hemispheric resections which involve removal or disconnection of one entire half of the brain or more focused resections including lesionectomies or lobectomies. Lobectomies involve the removal of an entire lobe of the brain, most commonly the temporal lobe. For selected people and pathologies, minimally invasive therapies such as magnetic resonance (MR)-guided laser thermal therapy can also be used.
Other types of epilepsy surgery are designed to lower the seizure burden. This can be done through implantation of a device such as a responsive brain neurostimulator or a vagus nerve stimulator. A procedure called a corpus callosotomy, which involves disconnecting the fibers that run between the two hemispheres of the brain, can be done in an attempt to stop the seizure from spreading and alleviating a very specific seizure type.
Lastly, diagnostic surgical operations may be performed such as implantation of a subdural grid and strip electrodes or depth electrodes placed with GPS-like technology for better delineation of the seizure onset zone or brain mapping of important neurological functions such as movement, sensation or speech areas.
The following are different types of surgical procedures commonly used to treat epilepsy:
  • Temporal lobectomy: This is the most successful type of epilepsy surgery, especially in the non-dominant side of the brain. Success rates of 60 to 80 percent have been reported, with or without anti-epilepsy drug (AED) therapy.
  • Extratemporal resection: In this procedure, dysfunctional brain tissue is surgically removed from areas outside the temporal lobes (sides of the brain). It is generally less successful unless a clear-cut tumor, vascular malformation, or other lesion is present. It can be particularly difficult to localize seizures in the frontal lobes (front of the brain) since this represents such a large portion of the brain.
  • Corpus callosotomy: It interrupts the spread of seizures by cutting the nerve fibers that connect one side of the brain (hemisphere) to the other. This nerve bridge is called the corpus callosum. The corpus callosotomy is indicated in some patients with drop attacks. In this procedure, the corpus callosum is sectioned or disconnected, usually at the front of the nerve bridge. The goal of this surgery is to prevent the spread of seizure discharges to both sides of the brain. This procedure does not stop seizure activity, but it lessens the risk of injury because it may limit the frequency and severity of seizures, especially those that cause falls.
  • Hemispherectomy: is most commonly performed in children with severe epilepsy. This procedure is often called a functional hemispherectomy, since most of the tissue is not really removed but disconnected. The surgery is a combination of removal and disconnection of one hemisphere, including the temporal lobe.

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