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Who Should Consider Adult Epilepsy Surgery?
Epilepsy is a disorder that results from surges in electrical signals inside the brain, causing recurring seizures.
Usually, medication can bring seizures under control. However, in one-third of people with epilepsy, seizures persist despite trials of numerous drugs.
If two different medications cannot help control your seizures, epilepsy surgery may be an effective option.
Determining if you're a candidate for epilepsy surgery
Before recommending surgery, neurosurgeons at the UPMC Movement Disorders and Epilepsy program must determine that:
- Your seizures are continuing after trying two different medications.
- Your seizures arise from one site in the brain.
- The site of the seizures has been pinpointed.
- The removal of the portion of the brain causing the seizures will not impair your ability to function.
Mapping brain function prior to surgery
Using state-of-the-art brain ping imaging technology, UPMC neurosurgeons are able to determine the part of the brain responsible for seizures. After the area is found, neurosurgeons perform extensive testing to determine any major problems with speaking, understanding, or other abilities that could arise if that area of the brain is removed.
In some cases, neurosurgeons briefly interrupt the function of the part of the brain considered for surgical removal and ensure that you can still do all the things you can ordinarily do.
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Types of Adult Epilepsy Surgery
If surgery is appropriate for treating your epilepsy, UPMC neurosurgeons perform an array of effective surgical interventions
Minimally invasive procedures
ROSA™ robotic system
ROSA™ is a new robotic technology that allows UPMC neurosurgeons to more accurately perform minimally invasive procedures for epilepsy and movement disorders. The advanced ROSA computer system is able to generate 3-D images of the patient’s brain, giving surgeons the option to look at the images from any angle and at any depth. Similar to a “GPS” system, ROSA provides a detailed road map of the brain’s vital structures and helps mark the exact areas surgeons need to reach.
Once the initial planning is complete, surgeons use ROSA’s robotic arm as a guide to perform very precise surgery with very thin recording electrodes. Because of this, surgeons are able to access the brain though tiny drill holes, which is much less invasive than the traditional approach of removing a portion of the skull.
In epilepsy surgery specifically, neurosurgeons guide the placement of electrodes through pre-planned pathways determined by ROSA’s mapping information. Then, using the robotic arm, surgeons guide needle-thin instruments to identify the brain areas where seizures occur.
Laser Ablation
Using laser ablation, UPMC neurosurgeons are able to treat seizures caused by epilepsy using heat. During the procedure, a laser fiber, guided by MRI technology, is directed toward the source of a patient's seizures through a small hole in the skull. Once the targeted area has been defined, surgeons use heat from the laser to destroy abnormal brain tissue responsible for causing the seizures. The entire procedure is viewed in real time on MR images that display thermal s outlining the distribution of heat to ensure safety and successful target treatment.
Additional Procedures
Resection of seizure focus
Using a combination of preoperative and intraoperative brain ping, this procedure involves removing the area of the brain that is causing seizures. As the most common type of epilepsy surgery, people often experience a 50 to 90 percent success rate for complete seizure relief.
This procedure may also be effective for people who have epilepsy located in areas of the brain other than the temporal lobe, or for patients who have been told that their epilepsy is inoperable.
Multiple subpial transection
This procedure involves making small incisions in the brain to interrupt seizure activity. Neurosurgeons perform this type of epilepsy surgery when seizures originate in areas of the brain that they cannot safely remove.
Vagus nerve stimulation
The vagus nerve serves as one of many highways of information for carrying messages to and from the brain. Because of its many connections to areas in the brain, the vagus nerve can be a key target for treating epileptic seizures.
During the procedure:
- A vagus nerve stimulator (VNS) is implanted under the skin near the collarbone. A wire under the skin connects the device to the vagus nerve in the neck.
- Neurosurgeons then program the device to produce weak electrical signals that travel along the vagus nerve to the brain at regular intervals. These signals help prevent the electrical bursts in the brain that cause seizures.
After the stimulator is implanted, a battery-powered device is programmed allowing patients to turn the device on if they feel a seizure about to start. People can also turn the device off if it is causing unpleasant side effects.
Responsive neurostimulation using the RNS® System
During this procedure, a small device, called a neurostimulator, is surgically implanted in the skull. Wires, or leads, are connected to the neurostimulator and placed in areas of the brain that have been determined to be responsible for seizure activity.
After the procedure, the neurostimulator is turned on and begins to monitor the electrical activity of the brain. When the device detects abnormal activity that could lead to a seizure, an electrical current is sent through the leads to the brain to prevent seizures. The device is similar to a pacemaker, which detects abnormal heart rhythms and responds by delivering electrical stimulation to correct the problem. In addition, the neurostimulator is reversible, and can be removed at any time.
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