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.
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.