There are times when antiepileptic medications (AED) do not suppress seizures in children. If a child is treated with 2 or more appropriate AEDs with no improvement, he or she is deemed pharmacoresistant (resistant to medication.) In such cases, it should be investigated if your child is a surgical candidate, since this offers the best chance of significantly reducing or stopping seizures.
Our Comprehensive Epilepsy Center offers several subspecialty clinics, including the surgical evaluation clinic. This specialized clinic is staffed by the epileptologist, neurosurgeon, nurse navigator, and sometimes, the physiatrist (Physical Medicine and Rehab physician). This team includes you and your child in a detailed discussion of the care plan. They discuss the results of all tests and the potential surgical treatment options available for your child.
We encourage your questions and input. As your child is able to understand, the physicians will speak to him or her. They will discuss in simple terms exactly what is going to be done. We find outcomes are better and recovery is easier when the parents and child understands the treatment, is able to have all questions answered, and mutually decides on the surgical option.
Resective Surgery Options
In rare instances, a child may have severe and uncontrollable seizures with weakness or paralysis of one side of the body. This typically results from damage to the brain caused by an underlying disease. For these patients, a hemispherectomy (a disconnection of the entire hemisphere) may be considered. In many cases, following surgery, the other side of the brain takes over many of the functions that were previously controlled by the side that was removed or disconnected. There are several types of hemispherectomies:
- Anatomical Hemispherectomy involves removing the entire half of the brain, including the frontal, parietal, temporal and occipital lobe. Deeper brain structures, such as the basal ganglia and thalamus, are left in place.
- Functional Hemispherectomy involves removing a portion of the brain’s hemisphere. The remaining tissue and fibers that communicate with the other side of the brain are disconnected.
- Peri-insular hemispherectomy involves disconnecting certain fibers that interrupt the communication network of the affected brain hemisphere.
- Functional Hemispherotomy – For children whose epilepsy arises from an entire hemisphere, we may perform a peri-insular hemispherotomy. This procedure involves a much smaller resection that is monitored by image-guidance technology. It disconnects the diseased hemisphere from the healthy one. As a result, there are fewer postoperative complications and minimizes morbidity.
Presurgical investigative studies may identify a primary seizure focus. In these cases, a topectomy may be performed to remove a specific part of the frontal, parietal, temporal or occipital lobes. It does not involve deeper brain structures. The area removed often is far away from areas where there are controls for vital functions (such as speech or motor skills).
This surgery involves removing one component, or gyrus, of the brain when there are not vital functions controlled by this area.
The brain has several areas known as lobes — the temporal, frontal, parietal and occipital lobes — and seizures may originate in any of these areas. A lobectomy is an operation to remove a significant portion or the entire lobe. Generally, seizures that originate in either of the two temporal lobes (one on each side of the head, just above each ear) are complex partial seizures. These resections are the most common of all epilepsy surgical procedures.
This procedure involves resection (or a surgical removal) of multiple lobes.
This procedure uses light energy to target a lesion or region of the brain responsible for causing epileptic seizures. It can also be used to destroy brain tumors. A laser probe is inserted directly into the target area. As light is delivered through the probe, temperatures in the target area begin to rise, destroying the unwanted tissue. This process has been shown to be highly precise. More information on Laser Ablation.