Multiple Subpial Transection
When
seizures originate in part of the brain that cannot be removed, surgeons may perform an
epilepsy surgery called a multiple subpial transection. In this type of epilepsy surgery, which has been commonly performed since 1989, surgeons make a series of cuts that are designed to prevent
seizures from spreading into other parts of the brain while leaving the person's normal abilities intact.
About 70 percent of patients who undergo a multiple subpial transection have satisfactory improvement in seizure control.
Corpus Callosotomy
Corpus callosotomy is a severing of the network of neural connections between the right and left halves, or hemispheres, of the brain. It is done primarily in children with severe seizures that start in one half of the brain and spread to the other side.
Corpus callosotomy can end drop attacks and other generalized seizures; however, the procedure does not stop seizures in the side of the brain where they originate, and these focal seizures may even increase after surgery.
Hemispherectomy and Hemispherotomy
These procedures remove half of the brain's cortex, or outer layer. They are used predominantly in children who have seizures that do not respond to medication because of damage that involves only half the brain, as occurs with conditions such as
Rasmussen's encephalitis,
Sturge-Weber syndrome, and hemimegalencephaly.
While this type of epilepsy surgery is very radical and is performed only as a last resort, children often recover very well from the procedure, and their seizures usually cease altogether. With intense rehabilitation, they often recover nearly normal abilities. Because the chance of a full recovery is best in young children, hemispherectomy should be performed as early in a child's life as possible. It is rarely performed in children older than 13.
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