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Epilepsy Surgery Procedures and Outcomes

Surgery is improving the quality of life for many people with intractable epilepsy. The Epilepsy Center at UC San Diego Health is recognized for its expertise in performing advanced surgical procedures to treat epilepsy.

The ideal surgery candidate has seizures that start in the same small area of the brain, in an area of the brain that is not critical for normal brain function and can be safely removed in a surgical procedure. Pre-operative testing is used to develop a precision surgical plan for each patient. Below are some of the surgical procedures we use to treat epilepsy:

  • Temporal Lobe Resection – Removes the anterior temporal lobe and portions of the amygdala and hippocampus (a common site to cause partial complex epilepsy, located under your temple).This is the most successful type of epilepsy surgery overall. At 1 year, 80 percent of patients are seizure free. At 5 years, 60 percent of patients remain seizure free, but may have to continue with medications. 
  • Laser Thermoablation Therapy – A minimally invasive laser surgery option for patients with conditions such as temporal lobe epilepsy or mesial temporal sclerosis, in which seizures originate from focal areas of the hippocampus. These conditions are often resistant to anti-seizure medications and the seizures typically worsen as the patient ages. Many patients just need an overnight hospital stay and can resume normal activities within two to three weeks. Laser surgery many also lower the risk of damaging patients' memory and language abilities.
  • Responsive Neurostimulation – A relatively new approach to treating medically uncontrolled partial onset seizures. This device automatically monitors brain signals and abnormal electrical events when needed. Surgically placed under the scalp, the neurotransmitter detects and records specific patterns that could lead to a seizure. The device responds with brief pulses of electrical stimulation intended to disrupt the abnormal brain activity before a seizure occurs. This is not felt by the patient. Each patient gets a take-home monitor so their brain activity data can be sent to the epilepsy doctor between office visits.
  • Vagus Nerve Stimulation – If the seizure focus is not well localized, patients may be candidates for vagal nerve stimulation (VNS). The vagal nerve is a cranial nerve that travels with the arteries and veins in your neck. Stimulation of this nerve has been found to alter brain chemistry which results in reduction of seizures for many patients. The nerve can be easily accessed and stimulated at low levels of electrical current that are barely felt by the patient. Stimulation of the vagal nerve by electric impulses at regular intervals can significantly decrease seizures in patients whose epilepsy has not responded sufficiently to medication. Vagal nerve stimulation is an outpatient surgical procedure performed while you are asleep.
  • Extratemporal Resection – Removes the portion of the brain lobe that contains the seizure focus, such as the frontal, parietal or occipital lobe.
  • Corpus Callosal Section – Cuts through the fiber "cables" that connect the two sides of the brain to reduce drop attacks or other generalized seizures that cause falls and injuries
  • Resection of Focal Structural Lesion – Removes small abnormal regions in the brain such as tumors, vascular malformations and cortical dysplasia. Depending onthe type of abnormality and the brain region these can be highly successful at eliminating seizures. 
  • Modified Hemispherectomy – Removes major areas of damaged brain tissue in multiple lobes on one side of the brain

Surgery is tailored to the individual, depending on the type and location of the seizure. During surgery, sophisticated technology is used to minimize the neurologic impact on functioning and language.

Outcomes

About 70 percent of patients are seizure-free after surgery and an additional 20 percent experience a major reduction in their seizures, allowing them to live a significantly improved lifestyle. The majority of patients require continued medical therapy, but usually at a lower dose.

Corpus callosal section is successful for treating drop attacks, although patients may continue experiencing other seizure types.

Appointments & Referrals

Locations

La Jolla

Hillcrest

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