Epilepsy surgery

The Walton Centre has one of the oldest and largest epilepsy surgery services in the country.

It is comprehensively undertaking a full range of invasive diagnostic procedures as well as therapeutic procedures.

 

Diagnosis

 Surgery for epilepsy can be extremely successful, but can involve a lot of complex tests and evaluations before the neurosurgeon is happy to offer the patient definitive surgery – some of these investigations themselves involve operations.

Tests involved and offered include – sophisticated imaging, often with functional MRI imaging; neuropsychological assessments; video surface EEG and on occasion operations to place depth electrodes to specific targets within the brain, and grids of electrodes placed over the brain. These allow the origin of the epilepsy to be located; a subsequent goal is to assess if this area of the brain can be removed without damage brain function.

 

Surgery 

If the source of the seizures can be located and that area of the brain can be removed without injuring function then surgery is possible.

Such procedures include:

  • Temporal lobectomy or selective procedure
  • Extra temporal removal of tissue shown to be epileptogenic
  • Hemispherectomy – in rare cases half the brain will be reomoved or disconnected
  • Lesional surgery
    • Tumours
    • AVMs
    • Cavernoma
    • Cortical dysplasias

If it is not possible to locate a single source of the seizures or the patient would suffer a neurological deficit as a consequence of removal of the epileptogenic brain then procedures can be carried out to modify the attacks, either their effect or to try to modify the electrical activity of the brain. Such procedures include

Awake craniotomies with neurophysiological monitoring to locate and preserve brain function, usually coupled with pre-operative functional localization by MRI – similar in principle to procedures carried out in oncology.

 

We perform different surgical procedures, including diagnostic testing, imaging, and surgical resections.

Surgical resections:

  • Temporal lobectomy
  • Extratemporal resections (frontal, occipital, parietal)
  • Lesionectomy
  • Resection for epilepsy in eloquent area.


Disconnection procedures:

  • Functional hemispherectomy
  • Corpus callosotomy
  • Multiple subpial transection.


Neuromodulation for epilepsy:

  • Vagal nerve stimulation
  • Deep brain stimulation.

 

Neurosurgeons:

Prof P Eldridge

Mr J Farah