Invasive or Resective Surgeries

Invasive or resective surgeries are performed when assessments consistently reveal specific area or areas of the brain where the seizures start. The objective is to remove or disconnect areas of the brain to disrupt the seizures.

A quick review of the anatomy of the brain will help us better understand epilepsy surgeries. +Learn More.

Lobectomy

Lobectomy is a type of surgery to remove a lobe of the brain.

The candidates for lobectomy are drug-resistant epilepsy patients with seizures generated in one of the lobes.

If the affected area is in the temporal lobe, a temporal lobectomy will be performed. Temporal lobectomy is the most common one, followed by frontal lobectomy.

During surgery, the surgeon will get access to your brain through a cut in your scalp and by removing a piece of your skull and dura, a membrane that covers the brain. The other team members working with the brain surgeon in the operating room will be taking images of your brain and EEG recordings to pinpoint the precise affected area of the lobe that is going to be removed.

At the end of the surgery the dura will be closed, the piece of skull put back and the scalp will be closed as well.

You will be transferred to the ICU for continuous observation. If you are medically stable, you will have a brief recovery at a hospital ward or at a rehabilitation unit. Doctors want to rule out potential complications before sending you home and returning to your regular activities.

General risks of brain surgery apply for lobectomy including bleeding, infection, weakness, numbness, need for further surgery, and medical risk of anesthesia. Specific risks for temporal lobectomy are memory loss, limited visual loss and speech problems, if surgery is on the left (dominant) side.

You will be followed up on a regular basis to evaluate the effect of the surgery and you may need to continue taking seizure medications until the doctors consider your seizures are under control.

For more information and frequently asked questions about lobectomy, read this printable resource.

Hemispherectomy

Hemispherectomy is performed when one side of the brain is not working well causing severe seizures affecting other areas of the brain and their brain functions.

This procedure is frequently indicated in children making it possible for them to have a better growth and development.

There are two types of Hemispherectomy:

The procedure to disconnect the affected hemisphere from the rest of the brain is known as Functional Hemispherectomy.
If it is necessary to remove a part of the hemisphere or the whole hemisphere, this type of surgery is known as Anatomic Hemispherectomy.

During surgery, the surgeon will get access to your brain through a cut in your scalp and by removing a piece of your skull and dura (membrane covering the brain). The brain surgeon will carefully remove the affected area of the hemisphere or disconnect the hemispheres by cutting the corpus callosum, the thick structure that connects both sides of the brain. This technique will help to protect the healthy hemisphere or healthy areas of the brain from damage caused by the seizures originated in the other hemisphere.

At the end of the surgery the dura will be closed, the piece of skull put back and the scalp will be closed as well.

Hemispherectomy, as any other brain surgery, has related risks and bleeding is one of them. Other risks include swelling of the brain, infection, and side effects from anesthetics.

You will be transferred to the ICU for continuous observation. After a few days, you will go to a hospital ward or to a rehabilitation unit to enhance recovery from surgery. When you go home you will continue with outpatient therapy and follow up appointments with the specialists. The doctors may recommend continuing taking anti-seizure medications and will let you know if the dose you are taking will be lowered or stopped.

For more information and frequently asked questions about hemispherectomy, read this printable resource.

Corpus callosotomy

The goal of a Corpus Callosotomy is to separate the two hemispheres by cutting the corpus callosum, thus making the seizures difficult to spread between the hemispheres.

Candidates for this type of surgery are people with severe, generalized and uncontrollable seizures that affect both hemispheres of the brain.

The procedure has evolved allowing surgeons to apply modifications to the surgery according to the distribution of the seizures and affected areas. These modifications include anterior callosotomy, posterior callosotomy and partial callosotomy.

During surgery, the surgeon will get access to your brain through a cut in your scalp and by removing a piece of your skull and dura (membrane covering the brain). In order to have a better view of the structures in the brain, the surgeon will use a microscope and special instruments designed for these types of surgeries.
Another option to perform the surgery is a mini-craniotomy (removal of a piece of the skull and dura) with the use of an endoscope. The endoscope is an illuminated fiber that is introduced into the brain to give a view of its internal structures.

The indications to use either one of these techniques vary according to the location and extent of the corpus callosum to disconnect. This procedure will make seizures difficult to spread between the hemispheres.

At the end of the surgery the piece of skull and dura will be put back in place and the scalp will be closed with stitches.

You will be transferred to the ICU for continuous observation. Any surgical treatment for epilepsy has potential risks, which will be evaluated carefully to determine the benefits of the procedure. Leg weakness and loss of coordination are the most common ones. Other potential risks include bleeding, infection, and stroke. No weakness or neurological deficit is expected after the surgery, but in the rare case of a complication, further admission to rehabilitation may be required to enhance recovery from surgery. When you go home, you will continue with outpatient therapy and follow-up appointments with the specialists. The doctors may recommend to continue taking anti-seizure medications.

For more information and frequently asked questions about Callosotomy, read this printable resource.

Your doctors will determine if an invasive or resective surgery is right for you. Make sure to discuss and plan follow-up care with your team of specialists.

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Lobectomy

Hemispherectomy

Corpus callosotomy

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