Brain Surgery for Epilepsy

According to the Institute of Medicine, only 4,000 epilepsy patients undergo surgery to treat their epilepsy in the United States each year, while as many as 100,000 patients are potential candidates for epilepsy brain surgery. One reason for the lack of utilizations may be the difficult recovery that can sometimes be associated with conventional surgery. The Henry Ford Comprehensive Epilepsy Center is leading the way in minimally invasive surgery for epilepsy patients.

Henry Ford: Pioneers in minimally invasive brain surgery

Our highly advanced laser techniques have broken new ground in shorter and safer surgeries for patients with epilepsy. In 2013, surgeons at Henry Ford Hospital performed the first two minimally invasive laser brain surgeries in Michigan, one for epilepsy and the other to treat a brain tumor. Both patients went home the day after the procedure.

Conventional brain surgery typically lasts several hours. It involves removing part of the skull and cutting through healthy brain tissue to reach the area needing treatment. After surgery, patients generally stay in the hospital for two to seven days and then are out of work for two to six weeks.

At Henry Ford, minimally invasive brain surgeries can be as effective as conventional brain surgery for certain patients, with much less risk and fewer side effects.

During this procedure:

• The neurosurgeon inserts a laser filament into your brain through a tiny (4mm) hole in the skull.
• Magnetic resonance imaging (MRI) shows neurosurgeons real-time brain function. These comprehensive images of your brain help the neurosurgeon avoid injury to areas that support important functions, such as speech and memory.
• The laser delivers extremely precise energy to abnormal areas of the brain that can cause epilepsy. This surgical removal of tissue is called ablation.
• The special software of the MRI makes it possible for the neurosurgeon to measure the temperature in different regions of your brain. This allows your neurosurgeon to make sure that the laser destroys the appropriate tissue while minimizing damage to healthy tissue.

The MRI-guided laser ablation procedure takes approximately four hours. Patients can usually go home from the hospital the next day.

Brain surgery for epilepsy

Epilepsy surgery is an operation on the brain to control seizures and improve your quality of life. The type of surgery used depends on the type of seizures and the area of the brain where the seizures start. There are three main types of epilepsy surgery:

• Focal resection: This surgery removes the portion of the brain responsible for seizures. While surgeons can remove an entire lobe of the brain during surgery, focal resection typically involves removing small parts of one lobe. The risk of complications is very low.
• Corpus callosotomy: The corpus callosum is a band of nerve fibers located deep in the brain that connects the two halves (hemispheres) of the brain. It helps the hemispheres share information, but it also contributes to the spread of seizure impulses from one side of the brain to the other. A corpus callosotomy is an operation that cuts the corpus callosum, stopping the seizures from spreading from one hemisphere to the other.
• Functional hemispherectomy: This is a procedure to remove all or almost all of one side of the brain. While it seems impossible that someone could function with only half a brain, the half that remains takes over many of the functions of the half that the surgeons removed.

Is epilepsy surgery right for me?

While surgery can help many people with epilepsy and seizure disorders, it is not an answer for everyone. If medicines have not helped to alleviate your seizures, our specialists will evaluate you to determine if surgery may be an option. During your evaluation, you may stay at one of our monitoring units periodically. The evaluation process typically takes between a few months to a year to complete.

Epilepsy surgery: Success rates

More than 80 percent of patients with temporal lobe epilepsy (the most common form of epilepsy) gain complete control of their seizures after surgery. Most of the remaining 20 percent of people report significant improvement in their symptoms and quality of life.

For patients with seizures caused by brain tumor or scar tissue, surgery to remove the tumor (or identified tissue) eliminates the seizures in most cases.