What Are the Types of Epilepsy Surgery? 

Medically Reviewed By Seunggu Han, M.D.
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Epilepsy is a condition that causes someone to experience seizures. Although anti-epileptic drugs (AEDs) are the first line of treatment in most cases, doctors may also recommend epilepsy surgery to decrease or prevent seizures. Around 70% of people with epilepsy may be able to live without seizures if they receive the correct treatment, according to the World Health Organization.

You may require brain surgery for epilepsy if your seizures do not respond to AEDs. There are different types of surgery that doctors recommend for different kinds of epileptic seizures.

Read on to learn more about epilepsy surgery. This guide includes information about the types of surgery, possible risks, and more.

Focal resection

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Focal resection can reduce the frequency and severity of seizures.

Focal resection is a type of epilepsy brain surgery that your doctor may recommend if the seizures occur in one part of your brain.

This may not be a suitable option if your seizures occur in a part of the brain that is too close to essential brain tissue.

Lesionectomy

A lesionectomy procedure is a type of focal resection.

Lesionectomy involves removing small brain abnormalities that are responsible for seizures. Traditionally, surgeons would open up the skull during a procedure called a craniotomy to access and remove the lesion.

However, surgeons can now carry out minimally invasive epilepsy surgery. They typically do this by creating burr holes in the skull and using an endoscope and laser to burn or remove the necessary part of the brain.

Hemispherectomy

During a hemispherectomy, your surgeon will usually remove part of the side of the brain that is responsible for the seizures. An anatomical hemispherectomy involves removing all four lobes of the relevant hemisphere.

Your surgeon may also carry out a functional hemispherectomy. This involves disabling the functions in the area causing the seizures without removing any part of the brain.

During a hemispherectomy, your surgeon may also carry out a corpus callosotomy.

Corpus callosotomy

Corpus callosotomy involves disconnecting one side of the brain from the other. This is to stop seizures from spreading.

Surgeons carry out a corpus callosotomy by cutting the corpus callosum, which is the nerve bridge that connects the two sides of the brain.

Corpus callosotomy can prevent seizures from spreading, but it does not prevent seizures from happening.

Multiple subpial transactions

During multiple subpial transactions (MST) surgery, your surgeon will partially cut the brain tissue. This is to prevent electrical charges in the brain cells from traveling and resulting in seizures.

Your doctor may recommend MST in cases where a surgeon is unable to remove the part of the brain responsible for seizures.

Deep brain stimulation

Deep brain stimulation is a procedure used to treat neurological symptoms such as tremors, stiffness, rigidity, and walking difficulties. It most commonly treats Parkinson’s disease, and your doctor may also recommend it for treating epilepsy seizures.

Your surgeon will implant insulated wires or electrodes via small holes in your skull. They will then connect the wires to a device called an internal pulse generator. They implant this device beneath your skin, typically near your collarbone.

Once implanted, the internal pulse generator will deliver electrical stimulation to block the nerve signals that are responsible for seizures.

Learn more about deep brain stimulation.

Vagus nerve stimulation

Vagus nerve stimulation uses an implanted device to control seizures.

Your surgeon will implant a small device under your skin. It suppresses seizures once they begin by controlling the vagus nerve. The vagus nerve is a long fiber that connects your digestive system, heart, and throat to your brain.

Vagus nerve stimulation may reduce the frequency of seizures by 45%–80%, according to the Brain Recovery Project.

Learn more about vagus nerve stimulation.

Responsive neurostimulation

Responsive neurostimulation (RNS) involves implanting a battery-powered device that your surgeon will implant underneath your scalp.

They will then connect the wires on the device to the area of your brain where the seizures occur.

The device is then able to detect patterns in the electrical activity in your brain. When necessary, it sends stimulating pulses to help prevent a seizure from occurring.

When do doctors recommend epilepsy surgery?

Your doctor may recommend epilepsy surgery if your seizures do not respond to AEDs. You will usually try several different AEDs before your doctor recommends surgery.

It is important that your medical team is able to locate the part of the brain where the seizures occur before they recommend surgery. They may then recommend surgery to either remove that part of the brain or separate it from the rest of the brain to prevent signals from traveling.

Both adults and children can undergo epilepsy surgery.

Which type of epilepsy surgery do I need?

If your seizures do not respond to AEDs and your doctor recommends epilepsy surgery, they may order a series of tests to help determine the right type of surgery for you.

Tests may include:

Your doctor will be able to explain the tests to you and answer your questions.

What are the risks of epilepsy surgery?

As with any surgery, there are possible risks of epilepsy surgery. Possible risks include:

  • memory loss
  • partial sight loss
  • mood problems such as depression

Your doctor or surgeon will be able to discuss the possible risks with you in more detail with reference to the specific type of surgery they recommend for you.

How do I prepare for epilepsy surgery?

Your doctor will inform you about anything specific you may need to do in the days or weeks leading up to your epilepsy surgery.

You may need to continue to take your epilepsy medication unless your doctor advises otherwise.

One of the most important things you can do to help you to prepare for your epilepsy surgery is to make sure you ask any questions you have about the procedure.

Being as informed as possible about what to expect during and after your surgery may help put your mind at ease and prepare both you and your family as much as possible.

Find out about what to expect with major surgery.

What are the other treatments for epilepsy?

Aside from surgery and AEDs, there are other treatment options that your doctor may recommend. Other treatments for epilepsy include:

  • seizure rescue medications to prevent a seizure from becoming a medical emergency
  • following a specific diet such as the ketogenic diet
  • complementary therapies

Find out more about other treatments for epilepsy.

When should I see a doctor?

Contact your doctor to discuss your current epilepsy treatment and what other options are available to you.

You should also contact your doctor if you are currently booked for epilepsy surgery and have questions about your procedure.

View our Epilepsy Appointment Guide for more advice.

Frequently asked questions

Here are some more frequently asked questions about epilepsy surgery.

What is the success rate of epilepsy surgery?

The success rate of epilepsy surgery can depend on the type of surgery. Some people may experience fewer seizures following surgery, while other people may not experience seizures at all anymore. Some people may be able to take fewer AEDs or a lower dosage following surgery. Your doctor will be able to answer your questions about the success rates of your specific surgery.

How long is epilepsy brain surgery?

Epilepsy surgery typically takes several hours. You may need to stay in hospital for around 5 days afterward, according to the charity Epilepsy Action.

Can epilepsy come back after surgery?

Depending on the type of procedure, epilepsy surgery may not completely prevent epileptic seizures. A 2018 investigation found that seizures can recur in up to 50% of people who undergo surgery for temporal lobe epilepsy that does not respond to AEDs. Your doctor will be able to provide more information about whether or not you can expect to continue to experience seizures.

Does epilepsy surgery leave a scar?

You may have a scar following brain surgery for epilepsy. It is important that you discuss any concerns about scarring with your doctor or surgeon. They will be able to advise on any steps you can take to manage your concerns and reduce your scar where possible.

Summary

There are different types of epilepsy surgery that your doctor may recommend. They may suggest brain surgery for epilepsy if your seizures do not respond to AEDs.

Some procedures involve removing the part of the brain responsible for the seizures. During other procedures, your surgeon will separate the two sides of the brain to prevent signals from traveling and causing seizures on the other side.

Contact your doctor if you wish to discuss your current epilepsy treatment and learn about other treatments that may be available to you. They will be able to provide you with information about surgeries they recommend and answer your questions.

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Medical Reviewer: Seunggu Han, M.D.
Last Review Date: 2022 Sep 16
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