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The University of Chicago Medicine - Comer Children's Hospital

Pediatric Epilepsy Surgery

If medication does not effectively control your child's seizures or your child doesn’t tolerate medication well, our epilepsy specialists may recommend surgery. Children’s brains are still developing, which actually can make them good candidates for epilepsy surgery. However, the percentage of patients we recommend for surgery is relatively small.

Surgical treatment options include:

  • Hemispherectomy
  • Responsive neurostimulation (RNS)
  • Stereoelectroencephalography (SEEG) with laser ablation
  • Stereotactic radiosurgery
  • Vagus nerve stimulation (VNS)

Sophisticated 3-D Imaging for Surgical Precision

At the Pediatric Epilepsy Center, we perform a number of seizure surgeries. Before your child has surgery, our experts will create 3-D images of the electrical activity in your child’s brain. To do this, we use noninvasive monitoring techniques that combine complex mathematical equations with MRI images and EEG data. The data we gather from these tests, otherwise known as electrical source imaging studies, helps our specialists determine if surgery is the best treatment option for your child. Then, our pediatric neurosurgeons use the data to help them carefully plan the safest, most effective and efficient approach to surgery. We are one of a handful of epilepsy centers that can offer this advanced technology to young patients. 

Minimally Invasive Surgery for Pediatric Epilepsy

Whenever it’s possible to get the best surgical outcomes using minimally invasive procedures, we will. In addition to performing traditional resections for focal epilepsy, we also offer minimally invasive, stereotactic high-precision techniques both for diagnosis and treatment of focal epilepsy.

Types of Surgery for Pediatric Epilepsy

Hemispherectomy

Hemispherectomy is also known as functional hemispherectomy and hemidecortication. In this procedure, surgeons remove and disconnect most or all of one side of the brain (one hemisphere). Because almost an entire side of the brain is removed, we only perform this type of seizure surgery:

  • In children who have very frequent and severe seizures with extensive damage in the affected hemisphere
  • In infants and children who are still capable of growing brain tissue to replace the removed brain tissue
  • When less aggressive surgeries won’t work
  • When the benefits outweigh the risks

Responsive neurostimulation (RNS)

Some children who have partial (focal) seizures may be candidates for RNS. First, a neurosurgeon implants a small stimulation device in the skull bone beneath your child's scalp. Up to two EEG leads are then placed in or on the brain at the precisely identified seizure source(s) and connected to the stimulator. Once powered, the stimulator monitors and records electrical activity in the brain. When the device detects abnormal activity, it delivers a mild electrical shock to stop the seizure. With RNS, your child will not be aware when a seizure is detected or interrupted. RNS may be an option when: 
Medication is not effective. 
Seizures originate from more than one source. 
The seizure origin(s) are in brain tissue that cannot be safely removed.

Stereoelectroencephalography (SEEG) and laser ablation

Our epilepsy team is the first in Illinois to offer MRI-guided SEEG and laser ablation surgery. If your child has a single, well-defined seizure focus, we may be able to use this minimally invasive procedure to safely and effectively eradicate the brain tissue where the seizures originate. First, during the SEEG procedure, your child’s surgeons will place electrodes into the brain to monitor his or her brain activity and precisely locate the seizure focus. The neurosurgeon then eradicates the seizure source with pinpoint accuracy, using a tiny laser applicator in the MRI scanner. Continuous real-time imaging allows the neurosurgeon to monitor effects of the treatment while performing the procedure. With SEEG and laser ablation, we are able to precisely identify and target the seizure source, while preserving as much of the surrounding healthy brain tissue as possible. This can also minimize side effects.

Stereotactic radiosurgery

Using highly focused x-rays, your child’s neurosurgeon can apply high doses of radiation directly into the epileptic focus. This minimally invasive procedure destroys the targeted area without damaging the healthy brain tissue around it.

Stereotactic radiosurgery is a particularly effective treatment for gelastic seizures (laughing seizures) and dacrystic seizures (crying seizures), which are most commonly associated with a benign brain tumor called a hypothalamic hamartoma.

Vagus nerve stimulation (VNS)

For some children, VNS can be an effective alternative to brain surgery. During this procedure, a surgeon implants a device in your child’s chest wall that sends electrical pulses to the vagus nerve in the neck. When successful, this will block the faulty electrical impulses in the brain that can cause seizures. The impact of VNS can be profound, and seizure frequency is reduced in more than 90 percent of cases. Additionally, many children experience improved mood and enhanced cognitive performance after VNS. The majority of children who have VNS will experience some seizure improvement, and about half of them will experience significant improvement and seizure control. Before we recommend VNS for your child, we will conduct an extensive evaluation to determine whether it’s the right treatment option. If the team decides VNS is right for your child, there is a good chance it will reduce your child’s seizures. However, he or she will probably have to continue on some dosage of seizure medication.