The main goal of epilepsy surgery is to decrease the number of seizures you experience, the severity of the seizures or, ideally, to become seizure-free. There are several different types of epilepsy surgery.
Epilepsy surgery is brain surgery to stop or reduce the number of seizures you’re having and/or their severity. Seizures are a burst of uncontrolled electrical activity between your brain’s nerve cells, which can result in changes in your:
Surgical approaches to manage seizures include:
Surgery for epilepsy is usually considered when:
Epilepsy surgery is most successful in people:
Healthcare providers perform pre-surgical testing on all people — children and adults — who are being considered for epilepsy surgery.
The goals of pre-surgical testing are to:
There are usually two levels of pre-surgical testing. Phase I involves nonsurgical tests. Phase II testing requires surgery. Your surgical team will decide which of these tests is appropriate for you.
Phase I tests include:
Phase II tests involve surgery to place electrodes on the surface of your brain or within brain tissue, which is closer to where seizures are happening than electrodes placed on the surface of your scalp (as in Phase I).
There are many types of surgical procedures for epilepsy. Here’s a summary.
In resection surgery, your neurosurgeon removes a specific portion of your brain. Your neurosurgeon may remove brain tissue in the area where the seizures begin or remove the abnormal brain tissue that’s causing the seizures. There are several types of resections, including:
These surgeries involve cutting the communication between the area of your brain generating the seizures and the remaining normal brain tissue.
This surgery involves using 3D computerized imaging to precisely focus radiation beams on a target to destroy the nerve cells that are misfiring and causing the seizures.
This surgery is less invasive than the other open surgeries. First, your neurosurgeon makes a small hole in your skull and an MRI scan guides the small probe to the area in your brain where the seizures begin. Focused laser energy is aimed at the seizure site. The energy changes into heat energy and destroys nerve cells at the seizure site. A computer program checks the temperature in nearby tissue to protect it from heat injury. This surgery is used if the seizure site is limited to a small area.
These procedures involve implanting devices to improve seizure control. No brain tissue is removed. They include:
First, your healthcare provider will shave the part of your head where they’ll perform the surgery. Your anesthesiologist will give you anesthesia so you’ll be asleep and not aware during your surgery. Your healthcare team will closely watch your heart rate, blood oxygen level and blood pressure.
Your neurosurgeon will remove a small area of your skull and set it aside. They may perform an EEG during surgery to confirm the exact location or source of the seizures.
In some cases, you may be woken up so you can respond to your neurosurgeon’s questions. This helps guide surgery and maps out areas in your brain that control vital functions, such as speech or movement. You won’t feel pain during this step of the procedure.
After brain mapping is completed, you’ll be put back to sleep. Your neurosurgeon will surgically treat the area of brain tissue where the seizures occur with the appropriately determined surgical approach. They’ll set your skull bone back in place and secure it. They’ll then close the skin covering your skull and bandage your head.
Epilepsy surgery takes several hours to complete.
Expect scalp and face swelling and headaches after epilepsy surgery. You’ll receive medications to treat these symptoms. Symptoms go away within a few weeks. Most people have a one-day intensive care stay and a three- to four-day hospital stay.
You’ll continue taking your anti-seizure medications for some time after surgery. The medications help protect your brain as it heals and lowers the chance of having seizures later on.
You’ll need plenty of rest as you slowly return to your normal daily activities in about four to six weeks. You can expect to return to work or school in about one to three months.
If you don’t have any seizures after a year or more, your healthcare provider may gradually reduce your medication dosage and eventually stop it.
Unless your vital functions have been affected (speech, memory, movement) you won’t need rehabilitation therapy.
All surgeries have risks. Typical surgical risks include:
In addition to these risks, brain surgery can affect vital functions such as memory, speech, vision and movement. These functions are located in different areas of your brain.
This is why healthcare providers perform extensive pre-surgery testing and brain mapping to locate where the seizures start. Your surgical team wants to make sure, to the extent that they can, that your planned surgery avoids these vital areas.
Although all surgeries have their risks, in general, less invasive surgeries may be potentially less risky. They also offer these benefits:
Less invasive surgical options include:
Ask your epilepsy surgical team if any of these less invasive surgeries are options for your epilepsy.
Removing (resecting) part of the temporal lobe is the most common type of epilepsy surgery. However, it’s also the most delicate surgery because of the functions carried out by this area of your brain. Risks from this surgery include:
Some of these problems may be temporary and will improve in time. Risks vary from person to person.
The goal of epilepsy surgery is to decrease the number of seizures, the severity of the seizures or, ideally, to become seizure-free. You may or may not be able to achieve this goal. Results are different for everyone.
Even if you aren’t completely free from seizures after surgery, you still may benefit from:
On the other hand, continued uncontrolled seizures have potential risks. If you already take anti-seizure medication and your seizures aren’t controlled, adding more medications isn’t very likely to stop your seizures (successful in less than 10% of cases).
Also, the more medications that are tried and don’t work, the lower your chance of seizure management. Other risks of ongoing, uncontrolled seizures include loss of memory and loss of social relationships over time if you withdraw from interacting with others.
You and your epilepsy surgical team will need to decide if surgery is a possible option for you. You’ll have to undergo extensive testing to see if you’re a candidate for surgery. If you’re a candidate, ask to speak with other people who’ve undergone the particular surgery that’s been recommended for you, and don’t hesitate to speak with a counselor. If you’re a candidate, only you can decide if the benefits of surgery outweigh the risks.
The success of your surgery depends on many factors, including:
Approximately 50% of people undergoing a surgical work-up for epilepsy may require insertion of small electrode wires into their brain for further invasive testing to identify the source of their seizures.
Up to 50% of people who undergo neuromodulation surgeries may experience better control of their seizures. Between 50% and 85% of people who have resection surgery or a hemispherectomy may experience significant improvement in seizure control and, in some cases, become seizure-free.
Ask your neurosurgeon about what outcome you can expect if you have epilepsy surgery.
A note from Cleveland Clinic
If you have epilepsy and medications have been tried and haven’t worked to control your seizures, surgery may be an option. Many different epilepsy surgeries are now available. Where the seizures start in your brain plays a big role in deciding which surgery is right for you. No two people with epilepsy are the same.
If surgery is an option for you, your team of epilepsy specialists will provide you with the information you need to understand the risks and benefits of the surgery so you can make the best decision. Be open and honest with your treatment team and never hesitate to ask your team any questions. They’re here to support your decision.
Last reviewed by a Cleveland Clinic medical professional on 03/14/2022.
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