Epilepsy Surgery

What Is Epilepsy Surgery?

Epilepsy surgery is an operation done on the brain to reduce or stop seizures.

Why Is Epilepsy Surgery Done?

Epilepsy surgery is done when a child's seizures aren't controlled by medicine or other treatments. The surgery is designed to stop all the seizures or, at least, to make them happen less often.

After surgery, some kids can stop taking their seizure medicine, but most just take less of it.

What Are the Kinds of Epilepsy Surgery?

Epilepsy surgeries include resective surgery and corpus callostomy:

• In resective surgery, doctors take out the area of the brain causing the seizures. Sometimes, this is only a tiny piece of brain; other times, a larger part is removed.
• In corpus callostomy, the corpus callosum (keh-LOW-sem) is cut. The corpus callosum is a bundle of nerve fibers that connects the two sides of the brain, letting them communicate with each other. If it's cut, a seizure that starts on one side of the brain can't spread to the other side.

What Happens Before Epilepsy Surgery?

A neurologist who specializes in epilepsy (an epileptologist) does tests to find the area in the brain where the seizures begin. Then, a group of medical specialists meets to talk about how to do the surgery. The group includes:

• epileptologists
• neurologists (doctors who treat problems with the brain and spinal cord)
• neurosurgeons (doctors who do surgery on the brain and spinal cord)
• neuropsychologists (health care providers who focus on how the brain affects our thoughts and actions)

The doctors may order tests, such as:

• CAT scan, MRI, and PET/MRI to look inside the brain
• EEG to see where in the brain the seizures are happening

They might also do these tests to see what part of the brain controls activities such as speech, memory, and vision:

• Wada test: Medicine injected into the bloodstream puts one side of the brain briefly “to sleep.” Then the doctor does speech and memory tests to see what part of the brain is used. 
• functional MRI: As the patient follows instructions, the MRI shows a change in blood flow in the area of the brain being used.
• electrical brain mapping: Electrodes placed on or inside the brain stimulate some areas to show which activities they control.

What Happens During Epilepsy Surgery?

A child will get general anesthesia to sleep through the surgery and not feel pain. Hair in the surgical area might be shaved to lower the chances of infection.

The neurosurgeon will take out a small part of the skull (called a craniotomy) to expose the brain. Depending on the type of surgery, the surgeon will either remove part of the brain or cut the corpus callosum. Then, the skull bone is put back so it can heal.

Most open epilepsy surgeries last 3–4 hours.

What Happens After Epilepsy Surgery?

After epilepsy surgery, your child will go to a special recovery area called a PACU (post-anesthesia care unit) for a few hours until the anesthesia wears off.

Depending on the surgery, your child may spend the first night in a special intensive care unit, then move to a neurosurgical unit for the rest of the stay.

Most children go home 3–4 days after the surgery. It takes about 3–4 weeks to recover fully from epilepsy surgery.

Are There Any Risks From Epilepsy Surgery?

Possible risks of epilepsy surgery include infection, bleeding, brain swelling, or complications from anesthesia.

Other risks depend on the type of surgery. These include increased seizures or changes in speech, vision, memory, language, or movement. The epileptologist and neurosurgeon will talk to you about your child's specific surgery.

How Can Parents Help?

Help prepare your child for surgery. Kids of all ages cope much better if they have an idea of what's going to happen and why.

Use simple, calming words to explain the reason for the surgery. Talk about the medical problem and why surgery is necessary. Depending on your child's age, you can talk a bit about the surgery and the recovery period. Your doctor can recommend age-appropriate books, articles, and other resources that can help.

After the surgery, your child will be sleepy and need rest. You can help by limiting visitors and visiting hours.

Your child will need medical follow-up and may need physical therapy or speech-language therapy after leaving the hospital. Schedule all follow-up visits as recommended by the doctor.

When Should I Call the Doctor?

At home, your child will need care as they heal.

Call the doctor right away if your child has:

• a fever above 101°F (38.3°C)
• swelling or redness at the incision site
• fluid leaking from the incision
• severe headaches
• nausea or vomiting