Epilepsy Surgery

Qualification

If medication and non-invasive surgical options are not assisting your epilepsy symptoms, you would be recommended epilepsy surgery. It might seem upsetting to consider brain surgery, but this alternative can be a very effective epilepsy treatment that will help remove your seizures.

A Neurosurgeon will work on the areas of your brain that are generating your seizure and will utilize maps & imaging to avoid damaging areas of your brain that are essential for memory, vision, movement, language and sensation.

There are various different types of epilepsy surgeries in which Dr Gurneet Sawhney has his expertise. These include Brain Surgery, Deep Brain Stimulation (DBS) and Vagus Nerve Stimulation. He relies on most advance techniques when it comes to treating of epilepsy through surgery. He is regarded as a top Neurosurgeon in Mumbai to perform critical surgeries such as various one's listed below.

Why is epilepsy surgery done?

Epilepsy surgery is done in order to:

  • Stop the seizures or make them less severe

  • Reduce the number and frequency of seizures

  • Medications fail to control seizures

  • Severe side effects of epilepsy medicines

  • Seizures hamper everyday life

  • Discharge of the seizure that spreads to other areas of the brain

  • Seizures occur on account of scar tissue, brain tumor, birth defect, or arteriovenous malformation (AVM)


In general, the aim is to enhance the quality of life of the patient.

At every stage of your epilepsy journey, Dr. Gurneet uses the newest tools for your best care. Brain Mapping & Intraoperative MRI (iMRI) help our expert team better understand how to treat your case in best way possible.

Our staff will prepare you before epilepsy surgery in Mumbai, so you will know exactly what to expect. After surgery, you will have follow-up tests and assessments. A coordinator will lead you through the process and help decide what recovery and rehabilitation services are required.

Epilepsy surgery is of two distinct types, viz.

  1. curative epilepsy procedures and

  2. palliative epilepsy procedures.

A. Curative epilepsy
Curative epilepsy procedures are aimed to remove the seizure focus area without causing damage to the brain or loss of brain function. Curative epilepsy procedures include lobectomy, cortical excision, and hemispherectomy that focus on removal of the area of brain that causes seizures. The neurosurgeon suggests curative procedures only if the diagnostic tests pinpoint to the exact origin of the seizure in the brain.

Temporal Lobectomy


This surgery is performed on patients suffering from temporal lobe epilepsy. There is nearly 70 – 80% reduction in the intensity of the seizure or complete control. The patient’s memory and language can be affected if the surgery is performed on the dominant hemisphere.

Cortical Excision


This surgery focuses on the removal of the outer layer of the brain at the focal area of the seizure. The cortical excision surgery has promising results with significant improvement in seizure control in nearly 50% of the patients.

Hemispherectomy


The neurosurgeon will remove the outer layer and the anterior temporal lobe in one section of the brain. It is performed on patients who suffers from intractable seizures and are weak on one side of the body. These patients usually have a damage hemisphere in the brain. Post hemispherectomy, the patients show remarkable improvement in the attention span, behaviour and cognitive functioning. Hemispherectomy is performed on children in most cases.


Temporal Lobectomy

This surgery is performed on patients suffering from temporal lobe epilepsy. There is nearly 70 – 80% reduction in the intensity of the seizure or complete control. The patient’s memory and language can be affected if the surgery is performed on the dominant hemisphere.


Cortical Excision

This surgery focuses on the removal of the outer layer of the brain at the focal area of the seizure. The cortical excision surgery has promising results with significant improvement in seizure control in nearly 50% of the patients.


Hemispherectomy

The neurosurgeon will remove the outer layer and the anterior temporal lobe in one section of the brain. It is performed on patients who suffers from intractable seizures and are weak on one side of the body. These patients usually have a damage hemisphere in the brain. Post hemispherectomy, the patients show remarkable improvement in the attention span, behaviour and cognitive functioning. Hemispherectomy is performed on children in most cases.



B. Palliative epilepsy
Palliative epilepsy procedures focus on reducing the frequency of seizures and/or their severity. The patients have to undergo in-depth testing to locate the exact source of the seizure and the impact of its removal. Palliative epilepsy procedures are critical procedures as they could affect the quality of life, especially mobility and speech. Palliative procedures include corpus callosotomy, multiple subpial transections and vagus nerve stimulation (VNS), deep brain stimulation (DBS).

Deep brain stimulation (DBS)


In a deep brain stimulation procedure, a pair of electrodes in placed in the brain. The generator that controls it is implanted in the chest. The frequency and its levels is customized as per the patient while the stimulation remains continuous.

Corpus Callosotomy


This procedure is a preventive surgery that focuses on preventing the spread of generalized seizures from their original location by disconnecting a section of nerve fibres across the corpus callosum. In the first surgery, the front area of the corpus callosum is sectioned. In case, the patient does not improve, then the rear area of the corpus callosum is treated in the same manner.

There have been instances of issue in left-right motor coordination, mutism and apathy in patients who have undergone total corpus callosotomy. This procedure is a curative and a preventive procedure done to prevent the spread or the intensity of seizure.

Multiple Subpial Transections


This procedure involves the creation of small incisions in the brain, especially in the seizure focus area so that they interfere with the spread of the seizure. This procedure is done in combination with lobectomy or alone. Multiple subpial transections are performed in the seizure focus area is located in the vital area of the brain, which cannot be removed.

Vagus Nerve Stimulation (VNS)


In this procedure, the neurosurgeon implants a device that performs functions similar to that of a heart pacemaker. This device produces electric signals to prevent seizures. The patient can switch on the device indicating the onset of a seizure and electric signals will be sent to the brain through the vagus nerve.

VNS is performed on patients who cannot undergo brain surgery. It is not a cure for epilepsy and is not successful on all patients. It can reduce the seizure of frequency to about 30%

The patient could suffer from mild hoarseness in the voice and tingling sensation in the neck in the event of stimulation.


Deep brain stimulation (DBS)

In a deep brain stimulation procedure, a pair of electrodes in placed in the brain. The generator that controls it is implanted in the chest. The frequency and its levels is customized as per the patient while the stimulation remains continuous.


Corpus Callosotomy

This procedure is a preventive surgery that focuses on preventing the spread of generalized seizures from their original location by disconnecting a section of nerve fibres across the corpus callosum. In the first surgery, the front area of the corpus callosum is sectioned. In case, the patient does not improve, then the rear area of the corpus callosum is treated in the same manner.

There have been instances of issue in left-right motor coordination, mutism and apathy in patients who have undergone total corpus callosotomy. This procedure is a curative and a preventive procedure done to prevent the spread or the intensity of seizure.


Multiple Subpial Transections

This procedure involves the creation of small incisions in the brain, especially in the seizure focus area so that they interfere with the spread of the seizure. This procedure is done in combination with lobectomy or alone. Multiple subpial transections are performed in the seizure focus area is located in the vital area of the brain, which cannot be removed.


Vagus Nerve Stimulation (VNS)

In this procedure, the neurosurgeon implants a device that performs functions similar to that of a heart pacemaker. This device produces electric signals to prevent seizures. The patient can switch on the device indicating the onset of a seizure and electric signals will be sent to the brain through the vagus nerve.

VNS is performed on patients who cannot undergo brain surgery. It is not a cure for epilepsy and is not successful on all patients. It can reduce the seizure of frequency to about 30%

The patient could suffer from mild hoarseness in the voice and tingling sensation in the neck in the event of stimulation.


Extensive Tests conducted for evaluation for Epilepsy Surgery

  • Continuous video– ECG Monitoring is done to monitory the activity during the seizure to understand limb movements, speech problems – during and after the seizure to identify its location in the brain.

  • Magnetic Resonance Imaging (MRI) – The MRI tests helps to detect tumours and brain abnormalities such as hippocampal atrophy, cavernous angiomas, corticaldysplasias

  • Positron Emission Tomography (PET) – The PET test indicates how the glucose, i.e. sugar is metabolized in the brain and helps in detecting brain abnormalities and dysfunctional.

  • Single-Photon Emission Computed Tomography (SPECT) – The SPECT test reveals the flow of blood to the brain tissue and throws insights on the working of the interior organs of the brain.

  • Neuropsychological Test – This test ascertains the brain functioning in terms of language and memory.

  • Wada Test (IntracarotidAmytal test) – The neurosurgeon will suggest this test to identify the dominant side of the brain for memory and language. The surgeon will get further insights on how to perform the surgery and its likely outcome.

  • Functional MRI (fMRI) – This is yet another test to locate issues in the brain relating to movement, memory and speech. At times, it is suggested as an alternative to the Wada test.

  • Electrical brain mapping or electrocorticography – These tests are performed to determine the exact location of the seizure focus and whether they lie extremely near to the functional areas.