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Each half of the brain is divided into four main lobes: frontal, temporal, parietal and occipital. A lobectomy is a treatment option when a child’s seizures originate from a specific, identifiable brain lobe and cannot be controlled by at least two medications. The neurosurgeon will use advanced precision imaging to locate and remove the affected lobe.
A temporal lobectomy is the most common type of epilepsy surgery.
Studies have shown that lobectomies, especially for children with focal epilepsy, offer high seizure-free rates.
If the child’s care team can pinpoint the specific area causing the seizures (seizure focus), that small section of damaged brain tissue is removed to stop or reduce the seizures. The neurosurgeon will use precise brain mapping to confirm the seizure focus and identify functional areas to avoid.
Laser ablation, also known as laser interstitial thermal therapy (LITT), is a minimally invasive surgery that uses precision technology to treat seizures at their source. Instead of removing brain tissue, this advanced approach uses targeted heat to eliminate the small areas causing the child’s seizures.
During the procedure, the neurosurgeon will make a small incision in the skull and use the MRI-guided laser ablation system, known as Visualase, to precisely direct laser energy to the affected tissue. Real-time monitoring allows the surgeon to see exactly which tissue is being treated, protecting the healthy brain tissue around it.
Benefits can include a shorter hospital stay and faster recovery compared with traditional open surgery.
This surgical procedure may be an option when seizures originate from one entire half of the brain. When a child with intractable epilepsy is having severe seizures, the goal is to stop the affected hemisphere from triggering seizures in or weakening the healthy side of the brain.
In a functional hemispherotomy, the neurosurgeon disconnects the connections between the sick hemisphere and the healthy one without removing the entire sick side.
When a child has drug-resistant epilepsy (intractable epilepsy) and isn’t an ideal candidate for removal of the seizure focus, neuromodulation is used to control the seizures. There are three primary forms of neuromodulation for kids, and we offer all of them:
The vagus nerve is the body’s longest nerve, and it connects the brain stem to vital organs such as the heart and lungs. The surgeon places the stimulator under the skin on the left side of the chest. Electrodes connect to the vagus nerve on the left side of the neck. The neurostimulator is about the size of a silver dollar.
The neurostimulator sends a regular electrical signal to the nerve and nervous system. The pulses are so mild the patient typically doesn’t notice. If a parent or caregiver notices a seizure about to start, they use a special magnet that can shorten the seizure.
Vagus nerve stimulation devices are approved by the U.S. Food and Drug Administration for children ages 4 and older.
In this type of procedure, a thin, battery-powered device is placed in the skull to monitor brain activity. One or two wires are placed into the area of the brain where the seizures originate, and when abnormal brain activity is detected, a signal can be sent within milliseconds to stop the seizure.
After the RNS neurostimulator is implanted, the child’s family is provided with a remote monitor, where they will download information stored from the child’s neurostimulator on a daily basis. This information is transmitted to the child’s care team to enhance the neurotransmitter and further reduce seizure activity.
Deep brain stimulation (DBS) is a treatment option for several neurological disorders, including drug-resistant epilepsy. This procedure can help children with different types of seizures, whether they start in one area of the brain or multiple areas.
During this surgery, a neurosurgeon places two thin electrodes in specific areas deep within each half of the brain near the thalamus. These electrodes deliver gentle electrical pulses that help regulate brain activity and reduce seizures. A small battery-powered device (like a pacemaker) is implanted under the skin in the chest or abdomen and connected to the electrodes. After surgery, the child’s care team will program the device to provide the best seizure control with the fewest side effects.
Norton Children’s Hospital is one of a small number of U.S. pediatric hospitals — and the only one in Kentucky — that offers deep brain stimulation for pediatric patients.