Epilepsy surgery
Nagpur Epilepsy Surgery: This is a surgery procedure aimed at removing that part of the brain from which seizures start. In most patients, epilepsy surgery is considered when seizures persist and at least two medicines are considered not to address them. Before undergoing surgery, several tests are conducted to evaluate the feasibility of surgery and which type of surgical method would best apply to it. It follows patients who suffer from medically refractory or drug-resistant epilepsy, thus reducing the occurrence, intensity, and associated complications with seizures and decrease dependence on medications with possible adverse effects.
It is performed to inhibit seizures or reduce their intensity. Surgery also takes place to minimize the deaths caused due to seizure, cut down the amount of anti-seizure medication administration, and thus minimize the side effects of these medicines.
Types of epilepsy surgery
Depending on seizure origin and patient age, the following types of epilepsy surgery are used:
- Resective surgery
- Parts of the brain where seizures occur are removed. More commonly, this involves the temporal lobes.
- Laser interstitial thermal therapy (LITT)
- MRI-guided laser ablates or kills seizure-causing tissue.
- Deep brain stimulation
- A neurostimulator is implanted to interrupt abnormal seizure activity with electrical impulses.
- Corpus callosotomy
- The hemispheres of the brain are disconnected, a typical surgery for children with widespread seizures.
- Hemispherectomy
- One side of the brain is removed. Typically performed in children with severe and localized seizures.
- This procedure disconnects the brain hemispheres without removing tissue; it is done mainly in children.
Candidates for Epilepsy Surgery
Surgery is generally considered when:
- Drug-Resistant Epilepsy:
- The patient has tried multiple anti-epileptic medications without achieving adequate seizure control.
- Focal Seizures:
- The seizures originate from one specific area of the brain (focal epilepsy). Identifying a single, localized area makes surgical intervention more feasible.
- Quality of Life Impact:
- Seizures significantly impair the patient’s daily functioning, quality of life, or pose safety risks, such as the risk of injury during a seizure.
- Surgical Eligibility:
- The area of the brain responsible for seizures can be safely operated on without causing unacceptable loss of important functions such as speech, movement, or memory.
Types of Epilepsy Surgery
- Resective Surgery:
- This is the most common type of epilepsy surgery, where the surgeon removes the area of the brain causing seizures. The most common form of resective surgery is temporal lobectomy.
- Temporal Lobectomy:
- Involves removing part of the temporal lobe, usually where focal seizures occur in people with temporal lobe epilepsy. This is often the most successful type of epilepsy surgery, with a high success rate in reducing or eliminating seizures.
- Frontal, Parietal, or Occipital Lobectomy:
- Seizures originating from the frontal, parietal, or occipital lobes may also be treated by removing the seizure focus from those areas, though temporal lobectomy remains the most common.
- Lesionectomy:
- In cases where seizures are caused by a specific lesion, such as a tumor, arteriovenous malformation (AVM), or cortical dysplasia, a lesionectomy may be performed. This involves removing the lesion responsible for generating seizures.
- Corpus Callosotomy:
- This procedure involves cutting the corpus callosum, the bundle of nerve fibers connecting the two hemispheres of the brain, to prevent the spread of seizures from one side of the brain to the other. It does not stop seizures altogether but can reduce the severity and frequency of certain seizure types, particularly drop attacks (sudden loss of muscle tone leading to falls).
- Hemispherectomy and Hemispherotomy:
- These are more drastic procedures typically used in children with severe epilepsy affecting one hemisphere of the brain. The surgery involves removing or disconnecting part or all of one hemisphere. Despite the radical nature of the procedure, children often recover remarkably well, with the remaining hemisphere compensating for lost function over time.
- Multiple Subpial Transections (MST):
- MST is performed when the seizure focus is near areas of the brain responsible for vital functions (e.g., language or motor control), and resection is too risky. Instead of removing brain tissue, the surgeon makes small cuts in the brain tissue to disrupt the pathways that spread seizures, without affecting critical brain functions.
- Vagus Nerve Stimulation (VNS):
- While not brain surgery, VNS is a less invasive option that involves implanting a device under the skin in the chest, similar to a pacemaker. This device sends electrical impulses to the vagus nerve, which helps regulate seizure activity. VNS does not usually eliminate seizures but can reduce their frequency and severity.
- Responsive Neurostimulation (RNS):
- RNS is a newer treatment where a small neurostimulator is implanted in the skull, with electrodes placed on or near the seizure focus. The device monitors brain activity and delivers electrical stimulation when it detects abnormal patterns that may lead to a seizure, aiming to stop the seizure before it starts.
- Deep Brain Stimulation (DBS):
- In DBS, electrodes are implanted into specific deep brain areas (usually the anterior nucleus of the thalamus) involved in seizure generation. A neurostimulator delivers continuous electrical impulses to modulate brain activity and reduce seizure frequency.
Pre-Surgical Evaluation
Before surgery, patients undergo a thorough evaluation to determine whether they are good candidates and to pinpoint the exact location of the seizure focus. The evaluation typically includes:
- Video Electroencephalography (Video-EEG):
- Continuous EEG monitoring with simultaneous video recording captures brain activity during a seizure, helping to identify the origin of the seizures.
- Magnetic Resonance Imaging (MRI):
- MRI scans are used to visualize the structure of the brain and identify any abnormalities (lesions, scar tissue, tumors) that could be the source of seizures.
- Functional Imaging:
- Techniques like positron emission tomography (PET) or single-photon emission computed tomography (SPECT) may be used to assess brain metabolism and blood flow in seizure-prone areas.
- Neuropsychological Testing:
- Assesses cognitive functions (memory, language, problem-solving) to determine if the area of the brain responsible for seizures is involved in critical functions, ensuring that surgery won’t significantly impair the patient’s cognitive abilities.
- Wada Test (Intracarotid Amobarbital Procedure):
- This test helps determine which side of the brain is responsible for language and memory functions, ensuring those areas are protected during surgery.
- Invasive Monitoring:
- If non-invasive methods cannot accurately pinpoint the seizure focus, invasive procedures such as stereoelectroencephalography (SEEG) or the placement of subdural grids may be performed to directly monitor brain activity from within the skull.
Risks and Benefits of Epilepsy Surgery
Benefits:
- Seizure Reduction or Elimination: Many patients experience significant seizure reduction or become seizure-free after surgery, allowing for better quality of life.
- Improved Quality of Life: Better seizure control can lead to improved cognitive, social, and emotional well-being, enabling patients to engage in activities they previously avoided due to seizure risk.
- Reduced Medication Use: Patients who achieve seizure freedom may be able to reduce or discontinue anti-epileptic medications, avoiding their potential side effects.
Risks:
- Neurological Deficits: Depending on the area of the brain being operated on, there is a risk of impairing critical functions such as memory, language, or motor skills.
- Infection or Bleeding: As with any surgery, there is a risk of complications like infection or bleeding.
- Seizure Recurrence: Some patients may continue to have seizures after surgery, although they are often less severe or frequent.
What happens during surgery for epilepsy?
- Medical Review : Your team will assess your medical history to ensure that stereotactic radiosurgery is indeed suitable for your condition. They will inquire about any implante devices, allergies, or claustrophobia you may have.
- Process Explanation: Your medical team will thoroughly explain the treatment process. These will be answered and sorted to alleviate concerns, therefore quelling your anxiety.
- Imaging Tests: You undergo imaging tests like computer tomography (CT). You also undergo magnetic resonance imaging (MRI) scans to be able to point out the exact location of the tumor. Patients suffering from a brain tumor will be required to have a brain MRI.
- Planning for Treatment: This is a very meticulous planning, probably simulation, in order to simulate the treatment process before one ever does it.
- Dosages Determination: The dosages are set by your physician. They could be a single dose of high radiation or small doses spread over more than one treatment. Your team of physicians may consider you for fractionate treatment or stereotactic radiotherapy.
- Preparation of Immobilization Devices: To achieve better accuracy in targeting the cancerous region with the least radiation exposure to normal tissues, you are required to be kept in a stationary position. You will therefore undergo preparation of immobilization devices, such as wearing head frames when the brain is to be treated with cancer.
At our Neurosys Multispeciality Center, we perform several key procedures including Craniotomy, which is primarily for the excision of brain tumors; V-P Shunt Surgery for treating hydrocephalus; surgeries for epilepsy; and operations targeting brain stem glioma. Beyond these, we offer a range of other neurosurgical services. If you have any questions that are not answere, please contact us through our Contact Us or Book your Appointment.