Doctor holding up EEG scan of brain

Types of Brain Surgery for Epilepsy

More than three million people in the U.S. suffer from epilepsy, according to the Centers for Disease Control and Prevention. About one-third of people with epilepsy don’t respond to medications used to treat seizures. For those people, surgery may be an option to eliminate or reduce seizures in the future.

There are two types of epilepsy surgery:

  • Traditional or “open” surgeries that require manually removing the portion of the brain causing seizures. The most common is a resection, which removes part of the temporal lobe (the section of the brain involved in vision, memory, language, comprehension, and more).
  • Minimally invasive surgeries that do not require opening the skull such as laser ablation. Other minimally invasive options that do not involve brain surgery, but use neurostimulation device implantations include:

Choosing the Best Epilepsy Surgery for You

If you and your doctor have decided that surgery is the best treatment for your epilepsy, your doctor will discuss your options based on the following factors:

  • where the seizures occur in your brain,
  • how well you respond to treatment, and
  • many other factors.

It is safe for both adults and children to have brain surgery for seizures. Your doctor will help you understand any additional risks for children and may not recommend surgery until your child reaches a certain age.

Preparing for Surgery

To prepare for surgery, your doctor will do some tests and evaluations. The most common are EEGs (electroencelphalograms used to find electrical activity problems in the brain), including overnight monitored EEGs in an epilepsy unit, and any other imaging tests.

Your doctor may also order other imaging tests such as MRI (magnetic resonance imaging) or PET (positron-emission tomography) scans, if necessary. You will also get a neuropsychological evaluation, which includes a variety of tests done by a neuropsychologist to get a baseline for your cognitive function prior to surgery. If the surgery is for a child under three years old, the doctor will order a developmental evaluation. 

Make sure you talk to your doctor about your test results including the reasons why surgery is the best treatment option. You should also schedule an appointment with your primary care doctor and notify your other specialists to let them know you are having neurosurgery.

In the six to eight weeks before your surgery, you should:

  • Eat a healthy diet.
  • Continue to exercise or remain as active as possible.
  • Stay hydrated.
  • Keep taking your regular seizure medications as instructed by your doctor.
  • Follow your doctor’s instructions for stopping other medications.
  • Talk to your family and friends about your upcoming surgery.
  • Discuss any concerns or feelings about the surgery with your doctor.
  • Work with your care team to determine what kind of support you will need after surgery. 

Before the surgery begins, you will meet with your surgical team and neurosurgeon to discuss the procedure and go over any questions or concerns you might have.

Laser Ablation Surgery for Epilepsy

Laser ablation is one of the best alternatives to invasive procedures like craniotomies (temporarily removing a piece of the skull to access the brain during surgery). Our goal is to reduce the number and severity of seizures or cure epilepsy completely. Laser ablation is extremely effective for treating seizures in patients who do not get better after taking epilepsy medications.

The Best Candidates for Laser Ablation Surgery

Before opting for surgery, your doctor will review your medical history and conduct image testing to learn more about your epilepsy. Most patients will not be considered for surgery until they try anti-seizure medications.

The patients who benefit most from laser ablation will have:

  • uncontrolled seizures after trying other therapies, medication, and dietary changes,
  • brain tumors or abnormal tissues that cause seizures,
  • seizures deep inside the brain where doctors cannot operate using traditional surgery,
  • small lesions or very specific areas where seizures occur,
  • hypothalamic hamartoma (tumors that form during fetal development), or
  • tuberous sclerosis (a rare disease that causes tumors or growths in the brain),
  • mesial temporal lobe epilepsy (the most common type of epilepsy), or
  • cortical dysplasia (brain abnormalities that form before a child is born).

How Laser Ablation Works

Laser ablation uses lasers to surgically remove the part of your brain that causes seizures. Patients who get laser ablation surgery for epilepsy will still be under general anesthesia (put to sleep) during the procedure. Your surgeon will make a small incision (cut) in the skull (about the size of a pencil) to place a guided laser probe into the brain. Your surgical team will use MRI (magnetic resonance imaging) to map out the exact spot they want to go. This method of using lasers and MRI mapping targets a seizure location with pinpoint accuracy.

Once they find the spot, the neurosurgeon will use lasers to target the spot in the brain where seizures occur. The laser will convert to thermal energy (heat) inside your brain and destroy the specific brain cells that cause seizures.

During the procedure, your team will monitor the temperature in nearby areas of your brain with a computer. Your spinal fluid keeps those areas cool to prevent damage to healthy brain tissue outside of the seizure location. Once the surgery is complete, your surgeon will close the small hole he or she made in the bone and the skin with a single stitch. You will spend only one to two nights in the hospital to recover after surgery.

Length of Surgery

A patient will typically be under anesthesia for four to five hours during laser ablation surgery. However, most of this time is spent on MRI scans and planning to verify the exact location and prepare for the procedure. The actual laser portion takes around one hour.

Laser Ablation: Epilepsy Success Rate

In many patients, this surgery will successfully stop their seizures; however, you may need more than one surgery. Some people still have seizures after brain surgery or seizures that come back later. Continue to see your neurologist and epilepsy care team after surgery to ensure the best recovery and outcome.

Benefits & Risks of Laser Ablation Surgery

The benefits of laser ablation surgery include:

  • a less invasive and safer procedure than an open brain craniotomy (temporarily removing a piece of the skull to access the brain for surgery),
  • a lower chance of damaging healthy tissues during surgery,
  • shorter surgery time,
  • smaller incisions and holes in the bone to insert the laser,
  • no need to shave the surgical site (patients keep their hair),
  • less scarring and pain after the procedure,
  • an ability to treat areas deep in the brain that a surgeon cannot reach,
  • shorter hospital stay and quicker recovery, and
  • fewer complications than traditional craniotomies.

However, laser ablation does have some risks. While they are rare, some reported complications include:

  • narrowing vision,
  • bleeding in the brain,
  • nerve damage, and
  • infection, which is a risk with any surgery.

Talk to your doctor about the risks for you or your child before deciding which surgery is best.

Laser Ablation Surgery Recovery

It takes about two weeks to recover fully and resume normal activity at home after leaving the hospital. However, some people may require more recovery time and your surgical team will give you a recovery plan that takes your health and medical history into account.

Learn What to Expect After Surgery

Make an Appointment with Our Neurologists

You will need a referral from your primary care physician or another provider to be seen in our Epilepsy Clinic. Call 801-585-7575 to schedule an initial appointment after you are referred. Our team will help coordinate your care to see an epileptologist (a neurologist who specializes in epilepsy) for evaluation and schedule any necessary testing for an accurate diagnosis. 

If you are a candidate for surgery, our surgical coordinators will help you schedule any necessary testing and diagnostic procedures in advance. We will also schedule an appointment for you to meet with the neurosurgeon.

Most epilepsy tests and treatment are covered by insurance. We will work with your insurance carrier to determine what is covered under your plan and obtain pre-authorization, as needed, before your treatment. If you have questions about what is covered under your insurance plan, contact your insurance carrier directly.