Resection means removing the portion of the brain that is causing seizures (seizure focus). Ablation involves using a medical device (such as a laser) to destroy the seizure focus. Surgeries are tailored to the child; one of several types may be recommended.
The brain is divided into four different lobes, or sections: temporal, frontal, occipital and parietal. A lobectomy involves surgically removing the lobe where the seizures are starting. The surgeon uses intracranial monitoring to precisely locate the seizure focus and avoid healthy tissue.
A temporal lobectomy is the most common type of lobectomy, followed by frontal lobectomy. These surgeries can be very successful in reducing or even eliminating seizures.
Cortical Resective Surgery
Cortical resection surgery involves removing the part of the brain that is causing seizures. This surgery is similar to a lobectomy, but does not involve removing an entire lobe of the brain.
Cortical resections can be effective when imaging tests or intracranial electrodes identify a specific area of the brain that is causing seizures.
Hemispherectomy / Hemispherotomy
Our team may recommend a hemispherectomy or hemispherotomy when a child’s seizures are coming from several different locations on the right or left side of the brain. These surgeries can be especially beneficial to children who are experiencing life-threatening seizures or seizures that are causing significant brain damage.
A hemispherectomy involves removing the connection between the right and left side of the brain. This prevents seizures from spreading from the diseased part of the brain to the part that is not causing seizures. A hemispherotomy involves removing the right or left side of the brain.
Laser ablation is a less invasive alternative to traditional epilepsy surgery that can be used to destroy (rather than remove) brain tissue that is causing seizures.
During laser ablation surgery, the neurosurgeon does not need to remove part of the patient’s skull to access the brain. Instead, he or she guides a laser applicator to the target area through a small incision in the skull, while the patient is in a magnetic resonance scanner. Laser light heats and destroys the target area, with minimal risk of potential damage to surrounding, healthy tissue. The technology uses functional MRI, stereotactic navigation and intraoperative neuromonitoring, so that the surgeon can see the target lesion in real time as it is being destroyed.