Rhode Island Hospital
593 Eddy Street
Providence, RI 02903
Photo courtesy of Christopher Demers, MD
Surgery is considered when seizures consistently originate in only one lobe (temporal, parietal, frontal or occipital) of the brain and in an area that can be safely removed without damaging vital functions. Surgery is not an option if it would impair important functions such as vision, speech or memory. Surgery can completely eliminate seizures in the majority of patients who undergo this treatment.
Lobectomies are surgeries that result in the removal of part of a lobe, with temporal lobe resection being the most common type of lobectomy. Extratemporal resection refers to the removal of part of the parietal, frontal or occipital lobes. Many patients become seizure free when the affected portion of the lobe is removed.
Lesionectomies are surgeries to remove lesions, which can cause or exacerbate seizures. Lesions can be tumors, abnormal blood vessels, hematomas or scars in the brain. Because surrounding brain tissue may also be affected by the lesion, surgery may also include removal of a small amount of tissue surrounding the lesion.
Multiple subpial transections is a type of surgery that may be performed when the part of the brain in which the seizures originate is too important to be removed. The surgeon may use surgical incisions to interrupt neural circuits to prevent seizures from spreading into other regions of the brain.
Corpus callosotomy is a type of surgery that may be performed when a patient suffers from a particularly debilitating type of seizure, namely atonic seizures or "drop attacks." These seizures may be prevented or dramatically reduced by surgery that partially or completely severs the corpus callosum, a band of nerve fibers located deep in the brain that connects the two hemispheres. The surgery in effect severs the connection, preventing seizures from spreading from one side of the brain to the other.
Functional hemispherectomy is the most extensive surgery, used only for a very rare and devastating form of epilepsy. In this procedure, the most seizure-prone and damaged half of the brain is functionally disconnected. Especially in younger patients, the remaining half of the brain can often successfully assume the functions of the detached half.