Weill Medical College of Cornell University

• Home
• The Comprehensive Epilepsy Center
• Epilepsy Surgery
• Brain Function Mapping

Epilepsy Surgery

Surgery is the only known cure for epilepsy. It is both safe and effective in carefully selected patients if done by a trained specialist in epilepsy surgery. Not all neurosurgeons specialize in epilepsy surgery therefore it is important that a patient know the experience and training of their surgeon.

Why Operate?

It should be noted that there is a known risk of sudden death in patients with epilepsy. In addition, it is possible to have repeated seizures that won't stop and can damage the brain. The risk of bodily injury is higher in patients with epilepsy. Although the medications that control epilepsy are powerful, the only known cure for this condition is surgery. If several medications have already been tried, there is little chance that another medication will make a difference.

Localizing the Seizures

The first step in determining whether neurosurgery would be an effective treatment for a child or adult involves evaluation to localize the seizures (find out where they start) to determine whether the seizures begin in one small part of the brain that might be treated surgically. A comprehensive healthcare team consisting of neurologists, neurosurgeons, neuroradiologists, neuropsychologists, nurse specialists, language therapists, and occupational and physical therapists works together to find evidence that points to a particular part of the brain as the source of seizures in the child or adult.

Chance of Cure

In carefully selected patients, as many as 80% can be cured of their seizures after a type of surgery called a temporal lobectomy. In addition, there is a good chance that even if all seizures do not completely stop after brain surgery, the seizures will be significantly improved.

If epilepsy is associated with a growth in the brain or an abnormal blood vessel, it can be cured in as many as 95% of patients. Epilepsy caused by developmental abnormalities in the brain, often found in children, can be cured in 40-60% of patients depending on MRI brain scan identification of an abnormal area.

Types of Epilepsy Surgery

There are two basic types of epilepsy surgery, curative surgery and palliative surgery.

Curative Surgery
The goal of curative surgery is to identify the specific area of the brain where seizures are generated and then to remove that area.,. 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 removed safely, without neurological symptoms, then surgery can proceed safely with a high risk of cure. If the area of brian generating the seizures is important for normal brain function, then surgery cannot be done safely and palliative surgery is considered.

Palliative Surgery
The goal of palliative surgery is to reduce the frequency and severity of seizures if there is no possibility of performing a curative surgery. Palliative operations often involve disconnections of the brain such as corpus callosotomy or multiple subpial transaction. These surgeries impede the initiation and spread of seizures. Other palliative surgeries include vagal nerve stimulation and deep brain stimulation. These operations involve implantation of devices to decrease seizures frequency and severity.