Surgery for Epilepsy
In patients who are suffering from epilepsy and whose seizures cannot be stopped by anticonvulsants surgery may be the only option. There are several treatment approaches for epilepsy. The approach that will be chosen basically depends on the brain area that is affected by the seizures.
Resection of temporal lobe is performed after the exact location of the onset of seizures has been localized. The affected and damaged part of the brain is removed. Some patients may completely benefit from this procedure. In those who have undergone the surgery and the seizures remain, the intensity of the seizures is drastically reduced.
Multiple subpial transaction is performed in case that the affected part of the brain simply cannot be removed. The goal of this procedure is to separate the affected part from the healthy brain by making small cuts. This way the seizures may occur but they cannot spread onto the surrounding tissue.
Corpus callosotomy is a surgical procedure in which hemispheres of the brain are separated. This type of surgery is done in children in case that seizures start in one hemisphere of the brain and then spread to the other hemisphere.
And finally, hemispherectomy is extensive surgical approach in which the superficial layer of the brain is removed. This radical procedure is performed in children whose one half of the brain is destroyed.
The bottom line is that surgery is performed only after all the medicamentous option has been applied and none of them succeeded in reduction or even elimination of the seizures.
Prior the Surgery
Before the surgical procedure the patient's brain and the surrounding structures need to be evaluated. EEG is performed to asses the brain activity and it can instantly detect seizures if they occur during the examination. EEG will additionally provide with the information about the damage of the previous attacks.
Additional imaging methods that may be helpful include CT scan, PET scan or MRI of endocranium. All of these may verify the structural abnormalities which may be the original place of the seizures.
Prior the surgery a patient needs to undergo functional MRI scan which will mark all the important structures of the brain that need to be preserved and saved from possible damage during the operation.
Risks of Surgery
After the surgery, a patient may have difficulties with memory, vision and speech. In some patients seizures become even more intensive than before the surgical procedure.
Partial paralysis is serious complication of the surgery, but the body movements can be re-established with physiotherapy.
The surgeon will compare the benefit to possible risks and decide whether the patient needs to undergo the surgical procedure or the risk is way too high for one to be operated.