The goal of surgery for pediatric seizure disorders is to reduce or eliminate refractory seizures in children to allow for improvement in cognitive and functional development. In some cases, surgery can result in seizure freedom. In other cases, surgery may reduce the frequency and severity of seizures. Since uncontrolled seizures can lead to brain damage or even death, surgery for seizure disorders can be life-saving and in many cases can improve a child’s quality of life and functional development.
Surgery for seizure disorders is both safe and effective when it is performed in carefully selected patients by a pediatric neurosurgeon specializing in seizure disorder surgery in children. Not all neurosurgeons have advanced training and expertise in seizure disorder surgery, so it is important to choose a surgeon who does. (See Doctors Who Treat Pediatric Seizure Disorders.)
There are two basic types of surgery for seizure disorders: curative and palliative.
The goal of curative surgery is to identify the specific area of the brain where seizures are generated and remove or disconnect that area from surrounding normal brain. A variety of specialized tests are performed prior to surgery to identify both the seizure-generating area of the brain as well as the specific functions of the brain. If the site of seizure onset can be identified and removed safely, without neurological deficit, then surgery can proceed safely with a high probability of a cure.
In some cases, only a small area of the brain requires resection. In other cases, the area will be larger, consisting of an entire lobe or multiple lobes of the brain in a procedure called a lobectomy. If seizures involve an entire hemisphere of the brain, or diffuse areas of a hemisphere, surgeons may disconnect the entire hemisphere in a procedure called a hemispherotomy. The goal of curative surgery is to remove or disconnect the entire seizure-producing network of neurons. Though it seems drastic, a child’s brain has great plasticity and, over time, other parts of the brain can take over the functions that are removed.
If the area of the brain generating the seizures is important for normal brain function, then surgery cannot be done safely and palliative surgery is considered. In some cases, if the seizure focus is deep and would present significant risk for surgical resection, laser ablation via a minimally invasive burr hole and placement of a laser probe can be performed to eliminate the seizure focus.
The goal of palliative surgery is to reduce the frequency and severity of seizures in cases where curative surgery isn’t possible. Palliative operations can involve “disconnecting” parts of the brain where seizures start or spread. For example, the brain structure called the corpus callosum is a major route of communication between the two hemispheres of the brain — and a pathway along which seizures can spread. A procedure called a corpus callosotomy eliminates that pathway by disconnecting the corpus callosum. The brain has other routes of information flow between the two hemispheres, but in certain types of seizures, the callosum can be the primary site of spread. Specific seizure types, most commonly drop attacks, are often significantly decreased by a corpus callosotomy.
Other options for palliative surgeries include vagal nerve stimulation, responsive neurostimulation, and deep brain stimulation. In these procedures, a neurosurgeon implants a device similar to a pacemaker to deliver electrical impulses to a cranial nerve or the part of the brain where the seizures originate. These electrical impulses decrease the frequency and severity of seizures.
Surgery for epilepsy in children is an advanced procedure that should only be performed by a pediatric neurosurgeon specializing in epilepsy surgery, after evaluation by a multidisciplinary team of epilepsy specialists. Prior to surgery a child should be evaluated by a multidisciplinary team consisting of neurologists, neurosurgeons, neuroradiologists, neuropsychologists, nurse specialists, language therapists, and occupational and physical therapists. These teams are found at major medical centers and include the Comprehensive Epilepsy Center at Weill Cornell Medicine and NewYork-Presbyterian. (See Doctors Who Treat Pediatric Seizure Disorders.)
Reviewed by: Caitlin Hoffman, M.D.
Last reviewed/last updated: June 2023