Epilepsy surgery is a procedure that removes an area of the brain where seizures occur.

Epilepsy surgery is most effective when seizures always occur in a single location in the brain. Epilepsy surgery is not the first line of treatment but is considered when at least two anti-seizure medications have failed to control seizures.

A number of pre-surgical tests are necessary to determine whether you’re eligible for epilepsy surgery and how the procedure is performed.

Epilepsy surgery may be an option when medications do not control seizures, a condition known as medically refractory epilepsy or drug-resistant epilepsy. The goal of epilepsy surgery is to stop seizures or limit their severity with or without the use of medications.

Why it’s done

Poorly controlled epilepsy can result in a number of complications and health risks, including the following:

• Physical injuries during a seizure
• Drowning, if the seizure occurs during a bath or swimming
• Depression and anxiety
• Developmental delays in children
• Sudden death, a rare complication of epilepsy
• Worsening memory or other thinking skills

Types of epilepsy surgery

Epileptic seizures result from abnormal activity of certain brain cells (neurons). The type of surgery depends on the location of the neurons that start the seizure and the age of the patient. Types of surgery include the following:

• Resective surgery, the most common epilepsy surgery, is the removal of a small portion of the brain. The surgeon cuts out brain tissues in the area of the brain where seizures occur, usually the site of a tumor, brain injury or malformation. Resective surgery is most often performed on one of the temporal lobes, an area that controls visual memory, language comprehension and emotions.
• Laser interstitial thermal therapy (LITT) is a less invasive surgery that uses a laser to pinpoint and destroy a small portion of brain tissue. Magnetic resonance imaging (MRI) is used to guide the laser the surgeon uses.
• Deep brain stimulation is the use of a device — permanently implanted deep inside the brain — to release regularly timed electrical signals that disrupt abnormal, seizure-inducing activity. This procedure is also guided by MRI. The generator sending the electrical pulse is implanted in the chest.
• Corpus callosotomy is a surgery to completely or partially remove part of the brain that connects nerves on the right and left sides of the brain (corpus callosum). This is usually used with children who experience abnormal brain activity that spreads from one side of the brain to the other.
• Hemispherectomy is a procedure to remove one side (hemisphere) of the folded gray matter of the brain (cerebral cortex). This surgery is generally reserved for children who experience seizures that originate from multiple sites in one hemisphere, usually the result of a condition present at birth or in early infancy.
• Functional hemispherectomy is a procedure primarily used in children that removes the connection nerves without removing actual pieces of the brain.