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What is epilepsy surgery?

Epilepsy surgery is a procedure that removes an area of your brain where your seizures originate. Epilepsy surgery works best for people who have seizures that always originate in the same place in their brains.

 


Why is epilepsy performed?

In many cases, epilepsy surgery can reduce, and sometimes even eliminate your seizure activity. Epileptic seizures that happen repeatedly can cause broken bones or other injuries from falling during a seizure, drowning, if the seizure occurs during a bath or swimming, brain damage from prolonged seizures or sudden death which is a rare complicating of epilepsy. 

There are several different epilepsy surgeries you can have depending on the types of seizure you experience and where it begins in your brain.

  • Resective surgery; this is the most common type of epilepsy surgery that removes a portion of the brain, usually about the size of a golf ball that is causing the seizures. This surgery can remove a lobe, a portion of a lobe or a lesion and is highly successful. 
  • Corpus callosotomy; this type of surgery severs the network of neural connections between the right and left hemispheres or halves of the brain and helps reduce the severity of seizures. This surgery is primarily used in children who have severe seizures that start in one-half of the brain and spread to the other half.
  • Hemispherectomy; this surgery is the most radical because it removes the outer layer of half the brain. It is used in children who have seizures because of damage to just one-half of the brain; in a few rare conditions, damage can be present at birth or appear in early infancy. The chance of a full recovery is best in younger children.

 


What are the risks of having epilepsy surgery?

Risks may vary depending on which variety of epilepsy surgery is being performed and the portion of your brain that is involved:

  • Memory problems; the temporal lobe handles memory and language functions, so surgery on this part of the brain may cause difficulties with remembering, understanding and speaking
  • Behavioral changes; surgery to the frontal lobe may affect behavior, including motivation, attention or concentration as well as impulse control, depression and mood changes.
  • Double vision; temporary double vision can develop after temporal lobe surgery. Vision problems may also occur with occipital lobe surgery
  • Reduced visual field; epilepsy surgery may result in a reduced visual field.

 


What can I expect during and after the procedure?

Before the procedure, to avoid infection, your hair will need to be clipped over the section of your skull that will be removed in the operation. The surgical team will most likely be able to shave the area in a way that other parts of hair will cover up the bald patch after the surgery. 

To monitor your heart rate, blood pressure and oxygen levels throughout the surgery, a small flexible tube will be placed in your vein. An EEG monitor may be recording your brain waves during the operation to better localize the part of your brain where your seizures start as well. 

Epilepsy surgery is usually performed under general anesthesia; this means you will be unconscious during the procedure. A small opening will be made in your skull to access the brain. In rare circumstances, your surgeon may wake you during part of the operation to help determine which parts of your brain control your language and movement. After the surgery, the window of bone is replaced and fastened to the remaining skull to heal.

After the procedure, you'll be placed in a recovery area so you can be monitored carefully as you wake up after the anesthesia. You may need to spend the first night after surgery in an intensive care unit; the total hospital stay for most is usually about three or four days. Your head will be swollen and painful when you first wake up; most patients need narcotics for the pain for the first few days. An ice pack on your head can also help. Most postoperative swelling and pain resolves within several weeks. It is unlikely that you'll be able to return to work or school for approximately one to three months; you should rest and relax the first few weeks and gradually escalate your activity.