Pediatric Epilepsy Surgery
Epilepsy surgery is often considered when seizures do not respond to medication. In general, children with epilepsy who have not responded well to 2 or 3 trials of appropriately selected anti-seizure medication should be considered for possible epilepsy surgery.
In epilepsy surgery, neurosurgeons remove (resect) the section of the brain where the seizures originate. The goal of surgery is to eliminate seizures or reduce the number and severity of seizures.
Brain surgery is an important treatment option for children with persistent seizures, including focal seizures, focal seizures progressing to generalized seizures, multifocal seizures from a hemispheric lesion, drop attacks and gelastic seizures.
We understand that the decision to proceed with epilepsy surgery can be a difficult one for families. But for some patients, epilepsy surgery is a wonderful option.
Depending on the type of epilepsy a child has, the chances of becoming free of seizures after brain surgery are as high as 80 percent for some patients. Others have about a 50 percent chance of becoming free of seizures after surgery, but they may also have fewer seizures or less severe seizures after surgery.
Pre-surgery evaluation
We utilize a team approach to identify optimal management options for patients with drug-resistant epilepsy. The evaluation of any child for epilepsy brain surgery will include input from specialists in epilepsy, electroencephalogram (EEG), neuroradiology, psychology, neuropsychology, neurogenetics, neurosurgery and anesthesiology — and, of course, ongoing input from patients and families.
The initial evaluation for epilepsy surgery typically includes:
- A detailed history of the nature of the seizures
- A neurological exam to look for clues regarding where seizures may begin
- A brain MRI scan
- A brain MEG scan
- Video recording of some seizures in the epilepsy monitoring unit
- Psychological and social assessments,
- Neuropsychological testing
We also perform positron emission tomography (PET), functional MRI (fMRI) and transcranial magnetic stimulation (TMS).
Watch: A Team Approach
Once these tests are completed, your child's neurologist will meet with you and your child. You'll also meet with one of CHOP's epilepsy surgeons to further discuss the options for epilepsy surgery. Your neurologist and neurosurgeon will work closely together, and with your family, to determine a treatment plan that will deliver the best chance of improving your child's symptoms and reducing seizures.
If your child is not already under the care of a CHOP neurologist, and you would like to explore the possibility of epilepsy surgery, contact the Pediatric Epilepsy Program for a second opinion consultation.
Our experience with epilepsy surgery
The Pediatric Epilepsy Program team is experienced in performing epilepsy surgery in children of all ages and with all types of epilepsy.
We offer the most advanced surgical techniques available in the treatment of children with epilepsy. Our highly skilled pediatric surgical teams are experts in the full array of procedures used to treat seizures. Using all of the information gathered during your child’s evaluation, we plan the most appropriate interventions, such as resection, disconnection, laser ablation, or placement of responsive neurostimulator electrodes.
Procedures include:
- Minimally invasive, robotic-assisted stereoelectroencephalography (sEEG) to pinpoint the precise source of the seizure activity in the brain and map parts of the brain that must be preserved
- Laser ablation brain surgery for a minimally invasive approach to corpus callosotomy, as well as treatment for hypothalamic hamartoma, as well as other small seizure foci
- Functional hemispherotomy to disconnect parts of the brain (using small craniotomies)
- Robotic-assisted responsive neurostimulation (RNS) for children with seizures coming from areas of the brain that control language, motor or sensory function
- Vagus nerve stimulation (VNS) to send small pulses of energy from the vagus nerve in the neck to the brain
- Craniotomy with dedicated anesthesia and intraoperative neuropsychology teams
We strive to use the least invasive procedures available, which offer many benefits to patients, such as less post-operative pain, decreased length of stay, lower risk of infection and improved outcomes.
By making epilepsy surgery safer and easier to tolerate, these treatment options become available to more children.
CHOP's dedicated pediatric anesthesiologists have specialized training in managing pain in children, and are prepared to keep your child comfortable and safe before, during and after surgery. Children have different needs than adults when it comes to anesthesia, and our team has both the technical skills needed to care for the smallest patients, as well special knowledge of the effects and dosages of medications for children of all ages.
