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Curative Surgical Treatment

A variety of curative surgical procedures are performed by neurosurgeons at the DMC/WSU Comprehensive Epilepsy Program. The goal of curative surgery is to remove the epileptogenic zone that gives rise to seizures and achieve complete or significant (at least 90%) improvement in seizures. Whenever possible, the most minimally invasive approach is used. These procedures are generally safe and well tolerated. The majority of patients experience substantial improvement — often gaining complete control of their seizures.

The following curative procedures are performed at the DMC/WSU Comprehensive Epilepsy Program:

Lesionectomy
A variety of intracranial lesions, including brain tumors and vascular malformations, can be highly epileptogenic and lead to refractory seizures. When one of these identifiable structural lesions is present, seizure outcome following surgery is excellent and generally better than in non-lesional epilepsy surgery. However, surgical treatment must be individualized and tailored to optimize seizure-free outcomes. In some cases, lesionectomy includes resection of additional tissue involved in seizure generation.

Temporal Lobe Resection
Temporal lobe epilepsy is the most frequent form of adult refractory epilepsy and also has the best prognosis following surgical treatment. Several different types of temporal lobe resection can be performed, depending on the anatomic site of seizure onset.

Extratemporal Lobe and Multilobar Resection
Extratemporal epilepsies may be lesional or non-lesional. Non-lesional extratemporal epilepsy represents a greater challenge for surgical treatment. Several surgical procedures are available to treat these types of epilepsy. Defining epileptogenic zone in extratemporal epilepsies can be challenging.

Hemispheric Procedures
Cerebral hemispherectomy remains one of the most successful surgical procedures used in the treatment of medically refractory epilepsy with seizure-free outcomes in 70 to 80 percent of cases. Hemispherectomy may be useful in patients with refractory epilepsy and diffuse unilateral hemispheric pathology. It is more commonly used in children, but can be used successfully in adults with certain conditions.

Hypothalamic Hamartoma Surgery
Hypothalamic hamartomas (HH) are uncommon, but well recognized, developmental malformations that are often associated with refractory seizures types. Surgical intervention appears to provide the best opportunity for achieving seizure freedom and halting the progressive decline in neurocognitive function associated with HH.
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