This page covers the different types of neurosurgery and what you should know when considering this option.
Neurosurgery (brain surgery) for epilepsy is an option for children, young people and adults who do not respond to anti-seizure medications.
Neurosurgery for children
For as many as one-quarter to one-third of children with epilepsy, anti-seizure medications are ineffective.
Neurosurgery should be considered early for these children if, after a number of detailed tests, the results show that:
- The seizures start in a specific part of the brain that can be clearly defined
- Removal of this area will not cause any further problems
- There’s evidence the child is experiencing medical, social and/or educational disability due to their seizures
- The child’s quality of life is likely to improve after surgery
- The potential benefits outweigh the risks of the child having brain surgery for epilepsy
Is neurosurgery right for my child?
Some types neurosurgery for epilepsy have higher success rates than others.
But we now know that, in many cases, the earlier the surgery is carried out, the better the result.
If doctors decide that surgery is an option for your child, you’ll have plenty of opportunity to discuss the benefits and risks with your child’s surgeon.
A play specialist (or other healthcare professional) may also be able to spend time with your child, helping them to understand what will happen.
If your child can also understand the risks and benefits involved, they should be included in the decision-making process.
You and your child may be put in contact with another family who have been through similar surgery.
They’ll know how you and your child feel and should be able to offer reassurance if you decide to go ahead with surgery.
Your child’s epilepsy team should be able to arrange this contact for you.
Tests before surgery for children
If your child is being considered for neurosurgery, there are a number of extra tests that they might have to have first.
Find out more about pre-surgery tests.
Children’s Epilepsy Surgery Service (CESS)
The Children’s Epilepsy Surgery Service (CESS) in England works with other NHS services to make sure children with epilepsy who could benefit are referred for neurosurgery.
The specialist CESS centres treat children from all over England, not just those from their local area.
The CESS centres are:
Birmingham Children's Hospital NHS Foundation Trust
bch.nhs.uk
Bristol Royal Hospital for Children
(Department of Paediatric Neurology)
uhbristol.nhs.uk
Great Ormond Street Hospital for Children NHS Foundation Trust
gosh.nhs.uk
King’s College Hospital NHS Foundation Trust
kch.nhs.uk
The Northern Children’s Epilepsy Surgery Services (NorCESS) is a joint service between Alder Hey Children’s NHS Foundation Trust (Liverpool) and Royal Manchester Children’s Hospital (Central Manchester University Hospitals NHS Foundation Trust)
Alder Hey Children’s NHS Foundation Trust
alderhey.nhs.uk
Royal Manchester Children’s Hospital
(Central Manchester University Hospitals NHS Foundation Trust)
cmft.nhs.uk
Resective epilepsy surgery
Resective epilepsy surgery is the most common type of neurosurgery for epilepsy.
It involves removing lesions (damaged tissue), structural abnormalities or parts of the brain that are causing the seizures.
Resective surgery operations include:
Lesionectomy
Removal of a lesion or an injured or damaged area of tissue structure, e.g. a tumour or a cyst.
Focal resection
Removal of an area of the brain where seizures are starting.
Lobectomy
Removal of one of the brain lobes. This is usually a large part of the temporal or frontal lobe.
Hemispherectomy
One hemisphere (side) of the brain is either removed or disabled.
This is not a common type of surgery, but is used to treat very severe epilepsy in children who already have damage to that hemisphere.
Who is resective epilepsy surgery for?
Resective epilepsy surgery can be considered for children, young people and adults, with or without MRI abnormalities, whose seizures do not respond to anti-seizure medications.
If resective epilepsy surgery is indicated as a potential treatment for people with learning disabilities or underlying genetic conditions, they should be referred for assessment.
Children and young people will be referred to a specialist hospital, where they’ll be assessed to see whether they should be referred on to a children’s epilepsy surgery service centre.
Adults will be referred to an adult epilepsy specialist hospital.
Your paediatric (children’s) or adult epilepsy specialists should discuss with you:
- The surgical-assessment process
- The benefits of the surgery
- The risks associated with the surgery
People with MRI abnormalities
Some children, young people and adults will have MRI abnormalities – specific lesions (damaged brain tissue) – that suggest a high risk of resistance to anti-seizure medications.
In this case, they will be referred to an epilepsy specialist hospital – for children or adults, as appropriate – for assessment, including whether resective epilepsy surgery might be right for them.
The types of lesions that might show up on an MRI include:
- Hippocampal sclerosis, a condition that affects memory (the hippocampus is a part of the brain involved in learning and memory)
- Malformations of cortical development – abnormal development in the womb of the cerebral cortex (the brain’s outer layer, which is involved in our highest mental functioning)
- Low-grade tumours associated with epilepsy
- Hypothalamic hamartomas – lesions in the hypothalamus (the part of the brain that helps maintain the body’s internal balance, including blood pressure, body weight, appetite, thirst and sleep cycles)
- Neuronal migrational disorders – a term covering a number of conditions that develop in the womb
- Tuberous sclerosis complex – a rare genetic condition that causes mainly non-cancerous tumours to develop in different parts of the body
- Vascular malformations, including Sturge-Weber syndrome
Disconnection procedures (palliative procedures)
A disconnection (palliative) procedure is not a cure for epilepsy.
Its aim is to stop seizures spreading from the part of the brain where the seizures start to other parts, or to make seizures less frequent.
This type of epilepsy surgery involves disconnecting surrounding parts of the brain from the part where the seizures start.
These operations include:
Corpus callosotomy
The fibres that connect the two halves of the brain are known as the corpus callosum.
In a corpus callosotomy, these fibres are cut to prevent seizures spreading throughout the brain.
This procedure is usually performed on children who mainly have seizures that cause weakness and frequent falls and injuries.
