Five Types of Adult Epilepsy Surgery
Epilepsy surgery has been a proven, safe, and effective option for many epilepsy patients with uncontrolled seizures since the 1980s. Many patients today benefit from minimally invasive surgery offered by Denver neurosurgeons at NeurosurgeryOne, which provides a better experience and fewer side effects.
Epilepsy surgery is even now available for patients with poorly localized seizures, offering nearly every adult with epilepsy a surgical option.
Epilepsy surgery has been shown to provide the following benefits:
- Improvements in both social and cognitive measurements.
- Reduced risk of seizure emergencies, injuries, and death.
- Elimination of or reduction in seizure medications.
- Reduced likelihood of experiencing anxiety and depression.
- Increased likelihood of returning to work and being able to drive.
- Reduced costs associated with epilepsy treatment.
If you have tried two or more different types of anti-epileptic drugs (AEDs) and still experience uncontrolled seizures, you are most likely a candidate for epilepsy surgery. NeurosurgeryOne’s Denver-area neurosurgeons are specially trained in epilepsy surgery and offer all five types of epilepsy surgery to control seizures. The type of surgery that is right for you depends on your seizure type, cause, and location, as well as personal factors. Our expert epilepsy neurosurgeons will discuss all viable options and potential benefits and side effects of each with you.
Read below to learn about each type of epilepsy surgery, its benefits, and pros and cons of each seizure surgery option.
- Thermal/Laser Ablation
- Responsive Neurostimulation (RNS)/NeuroPace
- Vagus Nerve Stimulation (VNS)
- Deep Brain Stimulation (DBS)
Resections for Epilepsy Seizures
Resections involve removing a small portion of the brain responsible for causing seizures. This area of the brain is referred to as the seizure focus. Resections are the most common type of epilepsy surgery.
Resections are typically best for epilepsy patients whose seizures:
- Originate from non-critical brain regions that don’t affect movement, speech, vision, or memory
- Arise from one area of the brain
There are three types of resection surgeries meant to control or eliminate epilepsy seizures:
- Temporal lobe resection is the most common type of epilepsy resection surgery and has the highest success rate. Nearly 70% of people who undergo a temporal lobe resection experience no or rare disabling seizures following surgery. In temporal-lobe epilepsy, surgery is superior to prolonged medical therapy.
- Frontal lobe resection is the second most common type of epilepsy surgery. Although its success rates are not as high as temporal lobe procedures, studies show that up to 50% of patients are seizure-free after surgery.
- Partial and occipital lobe resection provides the highest chance of success in patients who have a structural abnormality, such as a tumor or scar tissue, that causes seizures.
As with all brain surgeries, risk of infection, speech or memory issues, stroke, loss of motor skills or vision, and an increase in seizures are possible side effects of resections. Similar to craniotomy recovery, patients typically spend 1-2 days in the ICU after surgery and then 1-2 days recovering in the hospital before going home. In rare occasions, epilepsy surgery patients may need inpatient rehabilitation before going home. The benefits of this type of surgery begin immediately after surgery.
Thermal Ablation for Epilepsy Seizures
Thermal/laser ablation is a minimally invasive procedure. The neurosurgeon uses MRI to guide a small probe to the area of the brain responsible for causing seizures. Also known as Laser Interstitial Thermal Therapy (LITT), this procedure uses laser heat to destroy the area responsible for the seizures. This minimally invasive epilepsy surgery procedure is effective, with patients experiencing up to 60% seizure freedom.
People with epilepsy of the following types typically benefit most from thermal ablation, or LITT:
- Patients with mesial temporal lobe epilepsy typically benefit most from LITT, compared to other surgical options like resections that could bring higher rates of side effects like memory decline.
- Patients with dominant-side temporal lobe epilepsy are also typically candidates for LITT.
- Patients whose seizures are caused by lesions, such as a blood vessel or small brain malformation or hypothalamic hamartoma.
Compared to resections, LITT patients may have a higher chance of seizure recurrence compared to resection. Yet, the side effects of LITT are less severe, particularly when seizures originate from parts of the brain that are difficult to access or remove.
Because thermal ablation is minimally invasive, recovery time is faster, as compared to more invasive epilepsy surgery options. Patients typically have minimal discomfort after the procedure and only spend a day or two in the hospital after the procedure.
Side effects of LITT can include swelling and headaches, which are often controlled with medication. Rarely, side effects may include complications such as nerve damage, brain bleeds, or vision impairments.
Responsive Neurostimulation (RNS)/NeuroPace Epilepsy Surgery
Responsive neurostimulation (RNS) uses a medical device known as NeuroPace to observe and address seizures caused by abnormal brain activity. Much like a pacemaker, the NeuroPace is implanted in the body and then automatically detects unusual brain patterns and sends electrical pulses to interrupt seizure activity.
During surgery, a neurosurgeon places leads into the portions of the brain causing seizures. The leads are then connected to the neurostimulator that is positioned and hidden under the scalp. Once the neurostimulator is programmed, people cannot feel the stimulation.
RNS is reversible and does not remove any portion of the brain. However, the neurostimulator is placed under the scalp in the skull, which does require more invasive techniques than other surgical options like deep brain stimulation (DBS). Recovery is quick, with patients typically in the hospital for only 1-2 days.
Epilepsy patients with focal or partial seizures are typically candidates for RNS. Patients who cannot have resection epilepsy surgery to remove the portion of the brain where seizures start or for whom resection surgery did not work may benefit from RNS. Approximately 50% of people who undergo RNS have positive results. Studies show that the benefits from RNS increase over time, with more than 60% of patients experiencing seizure freedom 3-6 years after surgery.
RNS does not have ongoing stimulation-related side effects of other stimulation-related epilepsy surgeries do. Like any surgical procedure, however, there is a low risk of infection or bleeding after RNS.
Vagus Nerve Stimulation (VNS) for Epilepsy Seizures
Vagus nerve stimulation (VNS) sends regular, mild electrical pulses to the brain through the vagus nerve in the neck to control seizures. A wire is attached to the vagus nerve and then a pacemaker-like device is implanted in the chest to send the electrical pulses. VNS sends consistent, regular nerve stimulation, and patients also can activate the device through a special magnet if they feel a seizure occurring. Newer technology enables VNS to respond to a patient’s heart rate.
Epilepsy patients with focal or partial seizures that are not controlled by medications may benefit from VNS. Some people with Lennox Gastaut Syndrome have found benefits from VNS.
VNS has been shown to reduce the length, frequency, and severity of seizures. Although complete seizure elimination is not possible with VNS, the procedure is an option for people who do not want to go through more invasive surgery. VNS is reversible and is the most minimally invasive of any epilepsy surgery.
Approximately 50% of patients undergoing VNS experience a reduction of seizures within four months of surgery, with up to 60% of patients having positive results 2-4 years after surgery.
Patients typically go home the same day as their VNS surgery. The VNS device is programmed in an outpatient setting a few weeks after surgery. For patients who try VNS and don’t find success, other epilepsy surgeries are still available as options.
Side effects of VNS may include hoarseness, sore throat, coughing, infection, or bleeding. VNS is not recommended for people who have throat disorders.
Deep Brain Stimulation (DBS) Epilepsy Surgery
Deep brain stimulation (DBS) is a neuromodulation therapy that utilizes electrical stimulation to control areas of the brain causing seizures. Electrodes are placed in the areas of the brain causing seizures, and a neurostimulator is programmed to send pulses through the electrodes to the target area.
Although DBS for epilepsy seizures was only more recently approved by the FDA, NeurosurgeryOne has been a world leader for years in performing DBS using robotic guidance with patients asleep (most DBS procedures are performed with patients awake). Another benefit to NeurosurgeryOne patients is that we place the neurostimulator in an outpatient procedure done at our Functional Neurosurgical Ambulatory Surgery Center (FNASC in Littleton, Colo., a suburb of Denver). This eliminates a second hospital admission and provides more convenient replacement and reprogramming of the device.
DBS is often a preferred surgical option for patients with limbic epilepsy and adults with generalized epilepsy. DBS may be an option for epilepsy patients who cannot benefit from resection surgery that removes a portion of the brain causing seizures. DBS is also a treatment option for epilepsy patients who do not have other surgical alternatives.
Patients who had DBS performed experienced a median 69% reduction in seizure frequency five years after surgery.
Risks associated with DBS include bleeding, infection, memory issues, and depression. There are also risks associated with the implanted device, including infection, mechanical or electrical issues. The full benefits of DBS for epilepsy may not be realized until up to two years after surgery.