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Epilepsy Surgery

Surgery is a safe, proven method for controlling or stopping seizures. It can improve a patient’s quality of life and prevent further damage to the brain. If your child with epilepsy has failed at least two anti-epileptic medications, or if your infant has a brain lesion and has failed one medication, they should be evaluated as soon as possible for epilepsy surgery.

At CHOC, we consider epilepsy surgery as early as possible in the treatment process. We approach surgery as a team, drawing expertise and input from our board-certified epileptologists and neurosurgeons, as well as our patients and their families.

For each child, we make custom recommendations based on advanced testing, medical history and a family’s preferences. We perform many types of epilepsy surgery, and have the ability to perform two-stage procedures. We can also treat patients who have had unsuccessful epilepsy surgery elsewhere.

Watch this video to learn about the process your family would go through if your child has epilepsy surgery at CHOC.

Pre-Surgery Testing and Evaluation

A comprehensive evaluation will help determine if surgery is appropriate for your child, as well as the best surgical option for them. Your child’s neurologist may order the following tests and procedures prior to surgery:

Electroencephalogram (EEG). Learn more about having an EEG.
Long-term video EEG monitoring. Learn more about long-term video EEG monitoring in our Epilepsy Monitoring Units.
MRI scan and/or functional MRI scan of the brain. Learn more about having an MRI.
PET scan of the brain
Magnetoencephalography (MEG)
Subtraction SPECT
Ictal SPECT
Neuropsychological testing. Learn more about having a neuropsychological test.

Using the valuable information gathered from these tests, our pediatric epileptologists and neurosurgeons work to determine the location in the brain where seizures start, and how they spread through the brain, which allows us to make an individualized surgery plan for each child.

Types of Epilepsy Surgery

We perform several types of epilepsy surgery, depending on the location of the seizures and their extent.

Surgery may involve the removal of a lesion or section of the brain, with the goal of stopping seizures from occurring.
In some cases, a part of the brain will be disconnected from another part, which won’t stop seizures but aims to prevent them from spreading.
Another type of epilepsy surgery is ablation, during which the surgeon makes a small incision in the head and inserts a laser that destroys the seizure focus.
For some procedures, our neurosurgeons utilize the minimally invasive ROSA robot to operate on the brain.

Comprehensive surgical options include:

Diagnostic Procedures

Strips: Subdural strips help determine in which half (hemisphere) of the brain seizures are originating. They are also used when access to a particular area of the brain may be somewhat limited.
Grids: Subdural grids are sheets or strips of electrodes embedded in a thin, flexible sheet of polyurethane. Within the grid are electrode discs made of a platinum alloy. An open craniotomy (a window cut into the skull to expose part of the brain) is used to surgically place the grids over and around areas suspected to be linked to a patient’s seizures.
Mapping: After the surgery to place depth electrodes, grids or strips, the child is observed for seizure activity. The child also often undergoes cortical stimulation or functional brain mapping several times to identify important functional areas that may be near the seizure focus. Information from the electrodes helps the epilepsy team define the area of the brain that is causing the seizures (the epileptogenic zone) and plan the second surgery, which involves removing the grids and possibly addressing the seizures’ cause.

Learn more about intracranial monitoring.

Minimally Invasive Approaches

Laser interstitial thermal therapy (LiTT): Patients with focal (partial) epilepsy that is resistant to medication may be candidates for laser interstitial thermal therapy. While the patient is asleep under anesthesia, the surgeon drills a small hole in the skull at the back of the head and with the help of MRI guidance, navigates a laser wire to the area that is causing the seizures. After using heat to destroy the affected tissue, the surgeon removes the wire and seals the incision. Compared to a craniotomy procedure, LiTT can mean a much shorter hospital stay and recovery time.
Responsive neurostimulation (RNS): For drug-resistant focal epilepsy treatment. Similar to a pacemaker that monitors and responds to heart rhythms, the RNS system is the first and only medical device that can monitor and respond to brain activity to prevent seizures at their source.
Deep brain stimulation (DBS): A neurointerventional technique that involves implanting electrodes and a pacemaker-like device to deliver pulses of electricity to specific areas of the brain. Learn more about DBS.
Vagus nerve stimulation (VNS): A small coil wrapped around the vagus nerve that sends impulses to the brain, VNS is often used when a child has multiple or widespread sources of seizures and is not a candidate for focal epilepsy surgery. Learn more about VNS.

Open Approaches

Temporal lobectomy: This procedure removes brain tissue from a temporal lobe. The temporal lobes are located on either side of the head just above the ear and can be removed safely. Only abnormal tissue is removed, and crucial brain areas are left intact. This is the most common procedure for older children and adolescents.
Extratemporal cortical resection: This procedure removes brain tissue from areas outside of the temporal lobes. This includes multilobar resections and hemispherectomies, which are the most common procedures used for younger children and infants.
Stereotactic lesionectomy: This procedure removes a lesion in the brain that is causing seizures.
Corpus callosotomy: This procedure cuts the band of nerve fibers that connect the two halves of the brain, interrupting the spread of seizures from hemisphere to hemisphere.

The Journey to Becoming 'Seizure-Free'

Kara's Story
Kara was having up to four seizures a day, which was taking a toll on her brain. After having surgery at CHOC’s Level 4 pediatric epilepsy center, she now lives seizure-free.

Ian's Story
Ian’s parents were surprised to learn that his sleepwalking was actually a sign of seizures. After having surgery at CHOC’s Level 4 pediatric epilepsy center, he now lives seizure-free.

Mareena's Story
For years, Mareena’s family went from doctor to doctor, trying to get control of her seizures. After having surgery at CHOC’s Level 4 pediatric epilepsy center, she now lives seizure-free.

Epilepsy Surgery: Myth vs. Fact

Evidence shows that more than 70 percent of patients with seizures may benefit from surgical intervention. Yet only a handful of these patients will end up having surgery because the procedure is feared, misunderstood or put off as a last resort. In reality, surgery is often more effective than any other treatment. At CHOC, we view surgery as an early treatment option for controlling seizures and will do our best to calm any fears your family may have.

Myth: Surgery is too risky. It is safer to try more medications.

Fact: Allowing seizures to continue uncontrolled is much riskier than having surgery. The longer a child experiences seizures, the more likely they are to have long-term damage to the brain, including learning disabilities, developmental delays and increased seizures. That’s why early, aggressive treatment of epilepsy is critical in order to prevent the severe consequences of epilepsy on the developing brain.

Myth: Brain surgery is too invasive.

Fact: Children are very resilient, and their brains are no different. The plasticity of a young brain allows it to adapt to changes and heal more easily than an adult brain. Most children recover quickly. The consequences of surgery are generally minimal, with no new neurological problems, improved seizure control and improved quality of life and development.

Myth: Brain surgery will change my child’s functional abilities or personality.

Fact: Most patients come out of surgery looking and acting the same way they did when they went into surgery, minus the seizures. The side effects are very minimal, with no effects on a child’s development or personality. In fact, the part of the brain being operated on is often improved after the seizures are stopped.

Myth: Brain surgery might leave my child in a vegetative state.

Fact: Many people worry brain surgery will result in some kind of impairment. While it’s natural to be concerned about the risks involved with a major procedure, serious complications are very rare. Your child’s epileptologist and neurosurgeon will explain the risks and reassure you about the safety of the procedure.

Having Surgery at CHOC

When a child needs a surgery, that child’s needs are very different than those of an adult patient needing the same or similar procedure. Everything at CHOC is tailored to kids, including our pediatric-trained staff, customized equipment and special guidelines including anesthesia and pain management. We also have child life specialists at the bedside, to reduce a child’s anxiety and help them understand the hospital and what’s happening. They also provide distractions and pain management techniques.