Seizures are abnormal electrical discharges in the brain that can result in sudden, uncontrolled movements, altered consciousness, or other unusual sensations. When seizures are refractory to medical management with antiepileptic drugs, neurosurgery becomes a viable option. Neurosurgery for seizures is typically considered in cases of focal epilepsy, where the seizures originate from a specific area of the brain.
One common neurosurgical procedure for epilepsy is a craniotomy and temporal lobectomy, particularly for cases where seizures originate in the temporal lobe. During a temporal lobectomy, the neurosurgeon removes a portion of the temporal lobe, aiming to eliminate or significantly reduce seizure activity. This procedure has shown success in improving seizure control and enhancing the quality of life for many individuals with medically refractory epilepsy.
Another approach is selective amygdalohippocampectomy, which focuses on removing specific structures within the temporal lobe, such as the amygdala and hippocampus. These structures are often implicated in temporal lobe epilepsy, and their removal can lead to better seizure outcomes.
Responsive neurostimulation (RNS) is an advancement in the field of neurosurgery for seizures. This involves the implantation of a neurostimulator device that detects abnormal electrical activity in the brain and delivers targeted electrical stimulation to interrupt or prevent the onset of seizures. RNS is particularly beneficial for individuals with focal epilepsy whose seizures cannot be completely controlled with medication alone.
The decision to pursue neurosurgery for seizures is made collaboratively between the patient, neurologists, and neurosurgeons, considering factors such as the location of the seizures, the impact on the individual’s quality of life, and the potential risks and benefits of the surgical intervention. Comprehensive preoperative evaluation, including detailed imaging studies, electroencephalograms (EEGs), and neuropsychological assessments, helps guide the surgical planning and assess the patient’s candidacy for the procedure. Patients may also require a cerebral angiogram and Wada test to assess the function of the portion of brain involved prior to performing surgery.
Postoperatively, individuals who undergo neurosurgery for seizures require close monitoring and follow-up care to evaluate the effectiveness of the procedure and manage any potential complications. Seizure outcomes vary, and some individuals may experience significant improvements, while others may still require additional adjustments to their treatment plan. Advances
Advances in neuroimaging, neurophysiology monitoring, and surgical techniques continue to refine the field of neurosurgery for seizures. Ongoing research aims to identify new targets for intervention and improve the precision and efficacy of surgical procedures. While neurosurgery for seizures is a significant undertaking, it has provided meaningful benefits for many individuals with refractory epilepsy, offering the potential for a life with reduced or eliminated seizure activity. Coaxial Neurosurgical Specialists will continue to work closely with your seizure neurologist and provide you with the best hope for relief.