Types of epilepsy surgery.
The right operation depends on where your seizures start and what that part of the brain does. The four procedures below cover most of what we offer. Each section describes the procedure and what to expect afterward. Your surgeon will explain which one applies to you and why.
Resection.
Resection removes the part of the brain where seizures begin. A section of skull is temporarily removed to reach the brain, the targeted tissue is removed, and the skull is replaced. We remove as little tissue as possible while still taking out the whole seizure focus. During the operation we may record directly from the brain surface, called electrocorticography, to confirm the extent of the abnormal tissue and to avoid critical areas. For the right patient, resection offers the best chance of stopping seizures entirely.
After resection. You will spend about two nights in the hospital while we monitor you for seizures and other changes. Tiredness, headache, and swelling or soreness around the incision are normal in the first several days. Depending on where the surgery was done, you may notice temporary changes in strength, sensation, vision, speech, language, memory, or coordination. Some people have no noticeable change. Others benefit from physical, occupational, or speech therapy during recovery. Most people return to their usual activities gradually, and your teams will give you specific instructions about incision care, activity, and when to return to work or school. Antiseizure medications usually continue for at least six months after surgery. Do not stop or change your medications unless your epilepsy provider tells you to.
Laser interstitial thermal therapy (LITT).
LITT uses heat from a laser to destroy the seizure focus without opening the skull. Under general anesthesia, we make a small incision in the scalp, drill a hole in the skull the width of a pencil, and pass a thin laser probe to the target. The probe heats the tissue while an MRI scanner monitors the temperature in real time, so we can control the size of the treated area and protect the surrounding brain. When the ablation is complete, the probe is removed and the incision is closed with a stitch and skin glue.
After LITT. Recovery is usually faster than after an open resection because the incision is small. You will spend two nights in the hospital. Fatigue, headache, nausea, or soreness for a short time are common. Most people return to their usual activities gradually, with specific instructions from your teams about incision care and activity. Antiseizure medications generally continue after LITT. Do not stop or change them unless directed by your epilepsy provider.
Responsive neurostimulation (RNS).
RNS is an option when seizures start in a region that cannot be removed safely, or when they start from more than one place. The RNS System is a small, battery powered device set into the skull, within the bone, so it does not protrude. Two thin leads with electrodes at their tips are placed in the areas where seizures begin and connect to the device. The device continuously records brain activity, recognizes the specific electrical patterns that come before your seizures, and responds with brief pulses of stimulation to interrupt them. Most people do not feel the stimulation.
After RNS surgery. Expect soreness, swelling, bruising, or tenderness around the incisions and the device site. These improve as you heal. Most people return to their usual activities gradually. The device does not stop seizures right away. For the first month it only records, and you will upload data at home every day. You then return to the neurology RNS clinic, where the team programs the device and adjusts it every one to three months based on your seizures and the recordings. Programming is individualized, and reaching the best settings takes about a year, sometimes longer. Improvement builds over time rather than appearing immediately. Antiseizure medications generally continue after implantation. Do not stop or change them unless your epilepsy team directs you to.
Common questions about RNS.
How long does the battery last? Typically seven to eight years, depending on your settings and lead placement.
How much hair is removed? Small strips one to two inches long are shaved where the two leads are inserted, plus a horseshoe shaped area where the device is set into the bone at the back of the head on the right side.
What should I expect from RNS? RNS is not a cure. We expect it to reduce how often seizures happen and how much they disrupt your life, and the benefit typically grows over the first year or two as settings are refined.
Where can I learn more? The manufacturer maintains patient information at neuropace.com.
Hemispherotomy.
Hemispherotomy is used when seizures come from most or all of one side of the brain. Rather than removing tissue, the surgeon disconnects the abnormal hemisphere from the rest of the brain, so seizures cannot spread to the healthy side. It is considered when one hemisphere is severely abnormal or damaged and is causing frequent, disabling seizures that medications have not controlled, and when the other hemisphere is healthy enough to support movement, language, learning, and behavior. Conditions that can lead to this situation include perinatal stroke, cortical malformations, and Rasmussen encephalitis. The operation is most often performed in children, though selected adults may be candidates.
After hemispherotomy. The first several days involve significant fatigue and are closely monitored in the hospital. Because the affected side of the brain was already damaged before surgery, some changes that might seem surprising are expected. There may be weakness on the side of the body opposite the surgery, and part of the visual field on that side may be lost. These changes are often present to some degree before surgery and can temporarily worsen before improving with rehabilitation. Physical, occupational, and speech therapy are usually recommended to help the brain and body adjust and to make the most of the healthy hemisphere. Recovery is different for every patient. Many children make substantial gains in walking, hand use, communication, and independence over time. The developing brain is remarkably adaptable.
A note on candidacy.
Epilepsy surgery is individualized, and not everyone is a candidate. The decision follows a full evaluation by a team of neurologists, neurosurgeons, neuropsychologists, and other specialists. If surgery is not the right choice for you, we will tell you what we recommend instead.