Epilepsy surgery is a highly specialized neurosurgical procedure designed to control or eliminate seizures in patients whose epilepsy does not respond to medication (drug-resistant or refractory epilepsy). When seizures arise from a localized area of the brain that can be safely removed or disconnected, surgery offers a chance for long-term seizure freedom and improved quality of life. Advances in neuroimaging, electrophysiological mapping, and minimally invasive techniques have made epilepsy surgery safer and more effective than ever before.
When to Consider Surgery
- Seizures persist despite trials of at least two appropriate antiepileptic drugs.
- Seizures originate from a single, well-defined brain region (focal epilepsy).
- The epileptogenic zone is not located in an essential functional area (language, movement, or vision).
- Seizures cause significant impairment, injuries, or psychosocial distress.
Early surgical evaluation is important, as prolonged uncontrolled epilepsy can lead to cognitive decline and emotional burden over time.
Pre-Surgical Evaluation
A thorough multidisciplinary assessment is performed to localize the seizure focus and ensure safety.
- Video-EEG Monitoring: Continuous recording of brain activity and clinical seizures to identify seizure onset.
- MRI Brain (Epilepsy Protocol): High-resolution imaging detects structural abnormalities such as hippocampal sclerosis, cortical dysplasia, or low-grade tumors.
- PET / SPECT Imaging: Functional scans show areas of abnormal metabolism or blood flow corresponding to the seizure focus.
- Neuropsychological Testing: Assesses memory, attention, and language to predict possible cognitive effects after surgery.
- Invasive Monitoring (if needed): Stereo-EEG (SEEG) or subdural grid electrodes precisely map seizure onset zones and nearby eloquent cortex.
Types of Epilepsy Surgery
- Temporal Lobe Resection (Anterior Temporal Lobectomy / Selective Amygdalohippocampectomy): Removes seizure-producing tissue; seizure freedom in 70–80% of selected patients.
- Lesionectomy: Removal of focal lesions such as tumors, cavernomas, or cortical dysplasia causing seizures.
- Extratemporal Resection: Tailored removal of seizure-producing areas in frontal, parietal, or occipital lobes, guided by cortical mapping.
- Corpus Callosotomy: Partial or complete cutting of corpus callosum to prevent spread of severe drop attacks or generalized seizures.
- Hemispherectomy / Hemispherotomy: For children with severe unilateral brain damage; removes or disconnects affected hemisphere to stop seizures and allow normal development.
- Neuromodulation Techniques: For patients unsuitable for resection:
Vagus Nerve Stimulation (VNS): mild impulses to vagus nerve to reduce seizure frequency
Responsive Neurostimulation (RNS): on-demand stimulation to stop abnormal brain activity
Deep Brain Stimulation (DBS): targets structures like anterior thalamic nucleus to modulate seizure networks
Risks & Complications
Epilepsy surgery is safe in experienced centers, but risks include:
- Temporary language or memory difficulties (depending on resection site)
- Infection or bleeding (rare)
- Transient visual field changes
- Persistent seizures (in a minority of patients)
Preoperative functional mapping minimizes these risks and preserves critical brain functions.
Recovery & Follow-Up
- Hospital stay: 4–7 days, depending on surgery type
- Light activity: within 2–4 weeks
- Continue antiepileptic medication initially; gradual reduction possible after 1–2 years if seizure-free
- Regular neurological and neuropsychological follow-up for optimal recovery
- Many patients experience improvement in independence, mood, and cognition after surgery
Prognosis
- Seizure freedom in 60–80% of patients (best outcomes in temporal lobe epilepsy)
- Improved seizure control and reduced medication in others
- Early surgery offers better neurological and psychosocial outcomes than prolonged medical therapy
Patient Advisory
Epilepsy surgery is a highly individualized treatment requiring detailed evaluation by a multidisciplinary epilepsy team. Each patient’s condition, brain anatomy, and seizure pattern are unique. The goal is maximum seizure control with minimal risk. Consult your neurosurgeon and epilepsy specialist for comprehensive assessment. Do not rely solely on online information when making treatment decisions.