Epilepsy Surgery

Having a child with epilepsy can feel overwhelming, especially when it comes to facing surgery. It may sound scary, but surgery is a safe, proven way to treat epilepsy that cannot be treated with medication and to improve quality of life. CHOC was the first pediatric epilepsy center in California to be given a level 4 distinction, meaning we provide the highest-level medical and surgical evaluation and treatment for patients with complex epilepsy. We help create the ideal care plan for your family and support you every step of the way.

What is epilepsy surgery and is it safe?

Epilepsy surgery is a neurosurgical procedure that removes the area of the brain where seizures occur to control or stop them from happening. Learn more about our epilepsy program. Brain surgery for epilepsy is a safe, proven method for controlling or stopping seizures. It can improve a patient’s quality of life and prevent further damage to the brain.

When is epilepsy surgery needed?

Epilepsy surgery is needed when medications are unable to help control seizures. This happens when a child has medically refractory epilepsy or drug-resistant epilepsy. Surgery helps to stop seizures or limit their severity without medication. If your child with epilepsy has failed at least two anti-epileptic medications, or if your infant has a brain lesion and has failed one medication, they should be evaluated as soon as possible for epilepsy surgery eligibility.

At CHOC, we approach surgery as a team, drawing expertise and input from our board-certified epileptologists and neurosurgeons, as well as our patients and their families. For each child, we make custom recommendations based on advanced testing, medical history and a family’s preferences. We perform many types of epilepsy surgery, and have the ability to perform two-stage procedures. We can also treat patients who have had unsuccessful epilepsy surgery elsewhere.

Pre-Surgery Testing and Evaluation

A comprehensive evaluation will help determine if surgery is appropriate for your child, as well as the best surgical option for them. Your child’s neurologist may order the following tests and procedures prior to surgery:

• Electroencephalogram (EEG). Learn more about having an EEG.
• Long-term video EEG monitoring. Learn more about long-term video EEG monitoring in our Epilepsy Monitoring Units.
• MRI scan and/or functional MRI scan of the brain. Learn more about having an MRI.
• PET scan of the brain
• Magnetoencephalography (MEG)
• Subtraction SPECT
• Ictal SPECT
• Neuropsychological testing. Learn more about having a neuropsychological test.

Using the valuable information gathered from these tests, our pediatric epileptologists and neurosurgeons work to determine the location in the brain where seizures start, and how they spread through the brain, which allows us to make an individualized surgery plan for each child.

Types of Epilepsy Surgery

We perform several types of epilepsy surgery, depending on the location of the seizures and their extent.

• Surgery may involve the removal of a lesion or section of the brain, with the goal of stopping seizures from occurring.
• In some cases, a part of the brain will be disconnected from another part, which won’t stop seizures but aims to prevent them from spreading.
• Another type of epilepsy surgery is ablation, during which the surgeon makes a small incision in the head and inserts a laser that destroys the seizure focus.
• For some procedures, our neurosurgeons utilize the minimally invasive ROSA robot to operate on the brain.

Surgical Diagnostic Procedures

Before undergoing epilepsy surgery, our team uses intracranial monitoring to learn more about the origin of a child’s seizures. During this surgery, an opening in the skull is made to expose the surface of the brain. Then small electrode strips or grids are placed over the surface of the brain to track activity during seizures. Once the procedure is complete, the scalp is closed.

• Strips: Subdural strips help determine in which half (hemisphere) of the brain seizures are originating. They are also used when access to a particular area of the brain may be somewhat limited.
• Grids: Subdural grids are sheets or strips of electrodes embedded in a thin, flexible sheet of polyurethane. Within the grid are electrode discs made of a platinum alloy. An open craniotomy (a window cut into the skull to expose part of the brain) is used to surgically place the grids over and around areas suspected to be linked to a patient’s seizures.
• Mapping: After the surgery to place depth electrodes, grids or strips, the child is observed for seizure activity. The child also often undergoes cortical stimulation or functional brain mapping several times to identify important functional areas that may be near the seizure focus. Information from the electrodes helps the epilepsy team define the area of the brain that is causing the seizures (the epileptogenic zone) and plan the second surgery, which involves removing the grids and possibly addressing the seizures’ cause.

Learn more about intracranial monitoring.

Minimally Invasive Epilepsy Surgery

• Laser interstitial thermal therapy (LiTT): Patients with focal (partial) epilepsy that is resistant to medication may be candidates for laser interstitial thermal therapy. While the patient is asleep under anesthesia, the surgeon drills a small hole in the skull at the back of the head and with the help of MRI guidance, navigates a laser wire to the area that is causing the seizures. After using heat to destroy the affected tissue, the surgeon removes the wire and seals the incision. Compared to a craniotomy procedure, LiTT requires a shorter hospital stay and recovery time.
• Responsive neurostimulation (RNS): For drug-resistant focal epilepsy treatment. Similar to a pacemaker that monitors and responds to heart rhythms, the RNS system is the first and only medical device that can monitor and respond to unusual brain activity with pulses or bursts of stimulation to prevent seizures at their source.
• Deep brain stimulation (DBS): A neurointerventional technique that involves implanting electrodes and a pacemaker-like device to deliver pulses of electricity to specific areas of the brain. Learn more about DBS.
• Vagus nerve stimulation (VNS): A small coil wrapped around the vagus nerve that sends impulses to the brain, VNS is often used when a child has multiple or widespread sources of seizures and is not a candidate for focal epilepsy surgery. Learn more about VNS.

Open Epilepsy Surgery

• Temporal lobectomy: This procedure removes brain tissue from a temporal lobe. The temporal lobes are located on either side of the head just above the ear and can be removed safely. Only abnormal tissue is removed, and crucial brain areas are left intact. This is the most common procedure for older children and adolescents with epilepsy.
• Extratemporal cortical resection: This procedure removes brain tissue from areas outside of the temporal lobes. This includes multilobar resections and hemispherectomies, which are the most common procedures used for younger children and infants with epilepsy.
• Stereotactic lesionectomy: This procedure removes a lesion in the brain that is causing seizures.
• Corpus callosotomy: This procedure cuts the band of nerve fibers that connect the two halves of the brain, interrupting the spread of seizures from hemisphere to hemisphere.

Epilepsy Surgery Recovery

Epilepsy surgery recovery varies based on the person and type of procedure. Most people can resume their regular activities two to eight weeks after surgery. Some people may need to stay in the hospital for several weeks for intensive therapy following certain surgeries.