Surgery

Surgical treatments may be recommended for patients who don’t respond to medication and have seizures that can be localized to a particular location in the brain (focal epilepsy).

All surgical procedures are performed by a team of adult and pediatric neurosurgeons with specific neurosurgical subspecialty expertise.

We provide several different surgical treatment options to best suit a patient’s individual condition and preferences, while offering the best possible results.

Deep Brain Stimulation

Deep brain stimulation is a neuromodulation therapy designed to change how brain cells work by giving electrical stimulation to the areas of the brain involved in seizures. A neurosurgeon places electrodes in a specific target area of the brain that causes the seizures. The electrodes provide electrical stimulation directly to the brain and to a specific neural circuit. This stimulation interrupts the abnormal brain signals, helping to stop the spread of seizures and restore normal function of the brain signals. 

Laser Thermal Ablation

Laser thermal ablation is a less invasive treatment, in which a small disconnection is created to regulate hyperactive brain circuits and the circuits causing epilepsy. An MRI is used to target the area of the brain involved in the seizures and to monitor the temperature in the brain during the procedure. A small catheter is guided through a small hole made in the skull to the target area. A laser is then used to deliver a set amount of thermal energy to the specific area, removing or destroying the brain cells.

Laser thermal ablation can remove a seizure focus with great accuracy. If needed, the procedure can be repeated to a wider area of the brain region to best manage seizures. 

RNS System (NeuroPace)

The RNS System is a medical device that can monitor and respond to brain activity, using a small, implantable neurostimulator connected to leads. A neurosurgeon positions the leads at the area of the brain causing the seizures and places the neurostimulator in the skull. The system comes with a simple remote monitor that patients can use at home to wirelessly collect information from the neurostimulator and transfer it to a database. Their doctor can access this data to review and monitor ongoing information about seizure activity and treatment progress. The doctor programs the device so that the patient does not feel or notice the stimulation. On average, the total amount of stimulation delivered by the system is less than six minutes per day.

The RNS System is a reversible treatment option that does not involve removing any brain tissue.

Vagus Nerve Stimulation

Methods that stimulate the nervous system are not yet curative, but are used to decrease the burden of seizures and/or medication. With such treatment, seizures are often shorter and less intense and recovery happens more quickly.

We currently offer vagus nerve stimulation (VNS). VNS stimulates the left vagus nerve, which runs along the neck to the brain, via a small generator implanted in the left chest wall. VNS modulates neural circuits that are excessively synchronized in patients with epilepsy. VNS stimulation is mild, well tolerated, and does not affect other brain activity.

Resective Surgery

Resective surgery is an option to remove the seizure trigger zones in patients who can function well with that section of brain excised. Resective surgery can completely eliminate seizures in the majority of patients.

Types of resective surgery include:

• Lobectomies are surgeries to remove part of a lobe, with temporal lobe resection being the most common type of lobectomy. Extratemporal resection is the removal of part of the parietal, frontal or occipital lobes.

• Lesionectomies remove lesions, which can be tumors, abnormal blood vessels, hematomas or scars, in the brain. Lesions can cause or exacerbate seizures, and are responsible for seizures in approximately 20 to 30 percent of patients who do not respond to medications.

• Multiple subpial transections may be performed when the part of the brain in which the seizures originate is too important to be removed. The surgeon uses surgical incisions to interrupt neural circuits to prevent seizures from spreading into other regions of the brain.

• Corpus callosotomy may be an option for patients with particularly debilitating types of seizures, namely atonic seizures or “drop attacks.” Partially or completely severing the corpus callosum, a band of nerve fibers that connects the two hemispheres of the brain, prevents seizures from spreading from one side of the brain to the other.

• Functional hemispherectomy is used only for a very rare and devastating form of epilepsy. The most seizure prone and damaged half of the brain is functionally disconnected. The remaining half of the brain can often successfully assume the functions of the detached half. 

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