Resective epilepsy surgery

Indications

Resective epilepsy surgery is considered when:

• seizures have persisted, despite trying two or three medications alone or in combination
• pre-surgical evaluation has identified the epileptogenic region in the brain
• it is possible to remove the epileptogenic area without affecting the critical functional areas of the brain

Before surgery

A complete and comprehensive pre-surgical evaluation is essential to locate the exact section or sections to be removed safely with minimal risk of deficits in cognition, memory, speech/language, motor function and vision. 

Many children need to undergo invasive monitoring (SEEG) to understand where the seizures are coming from and whether the area of the brain producing seizures can safely be removed without causing functional deficits.

The surgeon and the team will explain the surgery to you and discuss all related issues. They will instruct you on any specific steps to take prior to the operation.  

They will also discuss symptoms your child may have after the operation, any intensive care and rehabilitation that will be required, and possible ongoing deficits and care. 

Surgery

The operation will take about six hours and will require a general anesthetic.

A portion of your child's head will be shaved. Part of the scalp and bone will be removed, and the dura membrane will be peeled back to expose the area of the brain to be removed.

During the operation, intraoperative intracranial EEG monitoring may be done to help the surgeon finely locate and remove or disconnect only those parts of the brain that cause the seizures. Adults and teens may be kept awake during part of the operation, using local anesthesia to eliminate pain, to perform tasks while the functionality of certain parts of the brain are mapped out. This is done to avoid removing functionally vital parts of the brain. This is very rarely done in children.

After the operation, the bone will be replaced and the scalp will be sutured closed. Your child will spend a few hours in the recovery room until they come out of anesthesia and one or two days in the intensive care unit, followed by about a week at the hospital.

After surgery

Side effects of the surgery depend on the specific areas of the brain that are removed. Temporary side effects of this surgery, which should disappear on their own in a few days, may include:

• scalp numbness
• nausea
• fatigue
• depression
• headaches
• difficulties with memory, speech or vision, and motor function

Rarely, some of these effects may persist. The surgeon and neurologist can talk with you about the side effects they expect for your child.

Your child may benefit from doing exercise therapy to improve any physical weakness or loss of co-ordination they may have. In the hospital, physical and occupational therapists will help your child and may show you some exercises. Your child may also need speech therapy if their speech has been affected.

Once your child is at home, they may need to continue using the services of a physical or occupational therapist in the community. Alternatively, they may be given some exercises to do on their own. The treatment team will discuss this with you and may be able to help you find a therapist.

The hair that was shaved for the procedure should grow back.

Most children are able to return to normal activities and school two or three months after surgery.

Anti-seizure medications should be continued after the surgery. As always, any change in dosage should be made with the advice and monitoring of your child's doctor. Sometimes the drugs can be stopped after a few seizure-free years.

If seizures occur after the operation, your child may require further careful evaluation (using tests and scans) and possible re-surgery. Alternatively, other treatments may be tried.

Complications and risks

Every surgical procedure has related risks, including infection, bleeding, cerebral edema and allergy to or complications from anesthetic. Your child's health-care provider will discuss the risks of this procedure with you in detail.

What can you expect from the surgery?

Every child is different. Depending on the nature of your child's seizures and the location of the epileptogenic region, surgery may result in complete seizure control or partial seizure control with less need for medication. There may also be some chance that the surgery will not improve things. Talk to your child's health-care provider about what you and your child can realistically expect as a result of the surgery.