Epilepsy Surgery

Epilepsy surgery is a medical procedure performed to treat epilepsy; a neurological disorder characterized by recurrent, unprovoked seizures. Seizures occur due to abnormal electrical activity in the brain. The goal of epilepsy surgery is to identify and remove or disconnect the specific area of the brain responsible for generating seizures, known as the epileptogenic zone.

Indications 

Epilepsy surgery is usually considered for the treatment of epilepsy when:

• Anti-seizure medications have failed to control or prevent seizures.
• The side effects of the anti-seizure medications cannot be tolerated. 
• Diet therapy, such as a ketogenic diet, has not proved to be successful in controlling seizures.
• The seizures are debilitating, severe, and frequent.

Surgery may also be indicated if the seizures are triggered by non-epileptic conditions, such as an arteriovenous malformation (AVM) or a brain tumor.

Preparation

Before surgery, patients typically undergo extensive testing, including EEG monitoring, neuroimaging such as MRI, or PET scans, and neuropsychological assessments to identify the precise location of the seizures and determine the feasibility of surgery. Other pre-surgical preparations may include:

• Informing your doctor of any allergies to medications, anesthesia, or latex
• Providing your physician with a list of any medications or supplements you are taking
• You may need to adjust or temporarily stop taking certain medications - especially those that can affect blood clotting
• Disclosing any recent illnesses or other medical conditions you may have
• Abstaining from food or drink for at least 8 hours prior to surgery
• Signing an informed consent form

Surgical procedure

There are several types of epilepsy surgery, and the choice depends on the individual's specific case. Various types of epilepsy surgery include:

• Resective Surgery: This involves removing the specific area of the brain where the seizures originate. The most common type of resective surgery is a temporal lobectomy, which involves removing part of the temporal lobe.
• Lesionectomy: Removal of a brain lesion, such as a tumor or abnormal blood vessel, causing seizures.
• Corpus Callosotomy: Severing the corpus callosum, the bundle of nerve fibers connecting the brain's two hemispheres, to prevent the spread of seizures between the hemispheres.
• Multiple Subpial Transection (MST): A procedure that involves making small cuts in the brain tissue to disrupt the spread of seizures without removing any brain tissue.
• Hemispherectomy: This is the surgical removal of areas of extensive damage or malformation that involve half the brain, or one hemisphere. This procedure is usually done in children with severe seizures.
• Laser interstitial thermal therapy (LITT): This is a minimally invasive resective surgery that uses a laser to pinpoint and destroy a small portion of seizure-causing brain tissue.
• Deep brain stimulation: This involves the use of a device that is placed permanently deep inside the brain. The device releases regularly timed electrical signals that disrupt seizure-inducing activity.

Epilepsy surgery is typically performed under general anesthesia. Your surgeon will remove a small piece of the skull (known as a craniotomy) to expose the brain. Depending on the type of surgery, your surgeon will remove the section of the brain causing seizures or implant a device to disrupt seizure activity. Then, the skull bone is replaced and fastened so it can heal.

Postoperative care

• After surgery, the patient is taken to a recovery room where vital signs, including heart rate and blood pressure levels, are closely monitored. 
• Pain management is provided as needed to ensure patient comfort. 
• Continuous seizure monitoring, often through electroencephalogram (EEG) recordings, may be done to assess the efficacy of the surgery on reducing seizures.  This monitoring helps identify any ongoing seizure activity and guides the adjustment of anti-seizure medications. 
• Wound care instructions will be provided to keep the incision area clean and dry. 
• The recovery period will include a gradual return to normal activities, with specific guidelines provided by the healthcare team. 
• The length of the hospital stay varies depending on the type of surgery and the individual's recovery progress.
• Regular follow-up appointments with the neurology and neurosurgery team are scheduled to monitor the patient's progress.

Risks and Complications

Common risks and complications associated with epilepsy surgery include:

• Bleeding
• Infection
• Injury to brain tissue
• Delayed healing
• Adverse reactions to anesthesia
• Problems with memory, speech, vision, movement, or language

Summary

Epilepsy surgery has been successful for many individuals, significantly reducing or eliminating seizures and improving overall quality of life. However, it is not suitable for everyone, and the decision to pursue surgery depends on various factors, including the type and frequency of seizures, the location of the seizure focus, and the individual's overall health.