Epilepsy is a brain disorder that causes unusual brain activity called seizures. It can also cause a loss of awareness and strange feelings. These procedures change the structure, activity, or connections in the brain to reduce seizures. 

One way to stop seizures is to change the brain's structure. This involves removing the part where they start. This surgery works best for seizures that start in one specific part of the brain (a focal seizure).

Another approach focuses on changing the connections in the brain. By severing the links between parts of the brain, these surgeries can stop a seizure from spreading. It's most effective if your seizures start in more than one area or if they start in one area that the surgeon can't remove safely. 

Less invasive options use electrical stimulation to change the activity in the brain, stopping seizures before they start.

At Carilion, we do brain surgeries using both traditional, open approaches, and less invasive approaches. These minimally invasive surgeries include robotic and laser surgery technologies. 

We do extensive testing to find the best surgical approach for you and your seizures. Talk to your epileptologist about if surgery is an option for you. 

Traditional (open) brain surgery

Traditional open epilepsy surgery requires opening the skull to access the brain.

A lobectomy, which removes part of a lobe of the brain, is the most common epilepsy surgery. Common areas of the brain for a lobectomy include:

• Temporal lobe: This part of the brain controls and receives information from your senses. It helps you understand and respond to the world around you. It's also a common area for epilepsy surgery.
• Frontal lobe: This part of the brain controls mood, impulse control, and the ability to concentrate and organize your thoughts. It's the second most common surgery.
• Parietal lobe: This part of the brain analyses data from your senses and the location of your body and other objects in space.
• Occipital lobe: This part of the brain analyzes information from your eyes. 

Other common open surgeries for epilepsy include:

• Lesionectomy: This surgery removes a small abnormal portion of the brain. A surgeon may use this approach when the seizure is due to a structural difference in the brain, like a tumor or abnormal blood vessels.
• Corpus callosotomy: This disconnection surgery severs the main link between the 2 sides of the brain. It's an option if you have severe seizures that involve both sides of the brain. It can help stop drop attacks (seizures that cause a sudden loss of muscle strength) and falls.

Less invasive procedures

Less invasive procedures use newer technologies to change the brain's structure, activity, or connections. These procedures are usually quicker, cause less tissue damage and discomfort, and have a faster recovery time.

Many of these procedures are robot-based surgeries. In these procedures, the robot helps the surgeon be more precise and work quicker. 

Laser ablation procedure

During a laser ablation procedure, the surgeon aims a laser through a hole in the skull the width of the lead inside a pencil. They use an MRI machine to enable pinpoint accuracy in finding the area of the brain causing seizures. The laser heats up and destroys the brain tissue, stopping the seizures. It's an option for small lesions in the temporal or other lobes.

Vagal nerve stimulation

A vagal nerve stimulation (VNS) implant is a device that sends regular, mild pulses of energy to the vagal nerve. It acts as a pacemaker for the brain. It can help reduce seizures.

The surgeon implants the VNS device under the skin of the chest. They attach a wire to the device and wrap the other end around the vagus nerve in the neck. It may be an option to treat focal or partial seizures in adults and children over 4.

Responsive neurostimulation

During the responsive neurostimulation (RNS) procedure, the surgeon places electrodes in the brain and connects them to a device in the skull. The RNS device can detect a seizure and provide energy pulses to stop it. The device can track seizure patterns and responses over time, so the device gets more effective over time.

The neurologist and neurosurgeon work together to tailor the device placement and programming to each person. It's an option for frequent and disabling focal seizures from 1 or 2 areas of the brain.

Deep brain stimulation

A similar technology is deep brain stimulation (DBS). The surgeon places wires deep inside the brain and a device in the chest. It releases regular energy pulses that disrupt abnormal brain activity.

At Carilion, we want to help you get the best control possible for seizures. Uncontrolled seizures can increase the risk of injury or death. They also have social, emotional, and financial effects. High doses of medicine can lead to side effects in both the short and long term.

Epilepsy surgery may be an option if you have severe, medicine-resistant seizures and other treatments aren't working well enough. You may have worked with an epileptologist to get your seizures under control using multiple medicines for more than a year.

Surgery may be a good option to treat these types of epilepsy:

• Temporal lobe epilepsy
• Generalized epilepsy
• Lesional epilepsy
• Non-lesional epilepsy

Each of these procedures and surgeries has specific requirements about who is a good candidate. It depends on what kinds of seizures you have and where your seizures start in the brain. 

You'll work with your epileptologist and brain surgeon to ensure this is the right treatment and to tailor it to you.

At Carilion, we approach epilepsy in a way tailored to you. We design our seizure care specifically for each person we treat. 

During the initial phase, we're working to find the best treatment options for you. It requires extensive testing to pinpoint the source of your seizures. Using various tests, including stereoelectroencephalography surgery, we plan your surgery down to the millimeter. 

​​You'll work with a nurse navigator to ensure you get all the testing and visits. There are often up to 8 touchpoints before the surgery; the nurse navigator helps with that.

The day of surgery and recovery is very dependent on the type of surgery you have. Talk to your care team about what to expect. Open surgeries typically have a longer recovery time, but you may be home that night or the next day for a less invasive procedure. We don't turn on or program the stimulators until you’ve healed. Getting the settings right to make them effective can take some time.

Risks of epilepsy surgery

The risks of epilepsy surgery vary based on what procedure you get. Some effects after brain surgery are short-term and will go away with time. The general risks of brain surgery apply—responses to anesthesia, bleeding, and infection. 

Brain surgery to remove parts of the brain can lead to issues with memory, vision, mood, motor skills, and speech. Talk to your care team about the risks of your surgery.