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 medicine.

What Are the Kinds of Epilepsy Surgery?

Epilepsy surgeries include resective surgery and corpus callostomy:

In resective surgery, the area of the brain causing the seizures is taken out. Sometimes, this is only a tiny piece of brain; other times, a larger part of the brain is removed.

In corpus callostomy, the corpus callosum is cut. The corpus callosum is the connection between the two sides of the brain, which lets 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?

Tests are done by a neurologist who specializes in epilepsy (an epileptologist) to pinpoint where in the brain the seizures begin. Then, in a group meeting (called the Epilepsy Surgery Conference), epileptologists, other neurologists, neurosurgeons, and neuropsychologists discuss the case to decide on the best surgical approach.

Testing may include:

• CAT scan, MRI, and PET/MRI to look inside the brain
• EEG, or electroencephalography, to see brain waves/electrical activity in the brain
• wada testing, which uses medicine injected through an artery into the brain to look at which side of the brain controls language and memory. Nowadays, this has largely been replaced with functional MRI, which is less invasive, but requires the child to do a language and memory task.
• electrical brain mapping, where electrodes are placed on or inside the brain during the first part of a two-part surgery. This shows where seizures happen and what the nearby parts of the brain do. Sometimes, this is done all in one stage rather than two.

What Happens During Epilepsy Surgery?

Hair around the incision might be shaved to reduce chances of infection. Your child will get general anesthesia to make your child feel like he or she is sleeping and ensure that there's no pain during the surgery.

The neurosurgeon will take out a small part of the skull (called a craniotomy) to expose the brain. Then, depending on the type of surgery, he or she will either remove part of the brain or cut the corpus callosum. When finished, 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 transfer 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?

As with any surgery, there are risks, such as infection, bleeding, brain swelling, or complications from anesthesia.

Other risks depend on what kind of surgery your child had. These risks 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 I Help My Child?

It's important to 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 appointments as recommended by the doctor.

When Should I Call the Doctor?

At home, your child will need care as he or she heals.

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