SURGICAL APPROACHES TO EPILEPSY: TUMOR SURGERY AND EPILEPSY SURGERY

There are two different reasons to do brain surgery in a patient with seizures. One we call “tumor” surgery, the other “epilepsy” surgery. A “tumor” in the brain may cause seizures. By tumor we mean not only abnormal growths and cancer but also abnormal blood vessels, areas of prior bleeding, and cysts, which may press on the surrounding brain causing seizures. The surgeon or neurologist may recommend removal of the tumor and the seizures may be controlled as well. Removal of these abnormalities is called “tumor” surgery, and its purpose is different from “epilepsy” surgery.

Epilepsy surgery is primarily intended to eliminate the seizures, whether or not a “tumor” is present.

Abnormalities of the brain causing seizures may also be subtle, just local abnormalities of cells or local scarring, with nothing pressing on the surrounding brain. In these cases, separating normal from abnormal (“epileptic”) tissue may be more difficult. Removal of these abnormal areas to control seizures is defined as “epilepsy surgery.” Sometimes scars, tumors, or blood vessel abnormalities are removed incidentally while removing the abnormal tissue causing the seizures. As we continue our discussion of surgery, we are focusing on epilepsy surgery and not on tumor surgery.

If there is a small, focal area of abnormality in the brain triggering seizures, it would seem far more logical to have that area removed surgically than to take anticonvulsant medication for a lifetime. Thus, surgery should be the treatment of choice for partial (focal) seizures if the focus is in a part of the brain that can be safely removed. While logical, this procedure is rarely undertaken. The brain has always been considered a sacred organ, one which should not be violated, and physicians have been reluctant to operate on the brain unless it is absolutely necessary. Patients were, and still are, afraid to have brain surgery. While elective surgery on most other organs is now considered routine, surgery on the brain is still considered by many to be a high-risk and frightening procedure, to be undertaken only as a last resort.

With amazing technological advances that have made it possible to locate a seizure focus in more people with epilepsy and to distinguish normal from abnormal brains, surgery has become far safer. Recent advances have changed our whole approach to children and adults with difficult-to-control seizures. Still, epilepsy surgery should be considered only when the seizures have not responded to appropriate medications given in appropriate doses and when either the seizures or the medications are significantly interfering with the daily life of the patient.

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SURGICAL APPROACHES TO EPILEPSY: TUMOR SURGERY AND EPILEPSY SURGERYThere are two different reasons to do brain surgery in a patient with seizures. One we call “tumor” surgery, the other “epilepsy” surgery. A “tumor” in the brain may cause seizures. By tumor we mean not only abnormal growths and cancer but also abnormal blood vessels, areas of prior bleeding, and cysts, which may press on the surrounding brain causing seizures. The surgeon or neurologist may recommend removal of the tumor and the seizures may be controlled as well. Removal of these abnormalities is called “tumor” surgery, and its purpose is different from “epilepsy” surgery.Epilepsy surgery is primarily intended to eliminate the seizures, whether or not a “tumor” is present.Abnormalities of the brain causing seizures may also be subtle, just local abnormalities of cells or local scarring, with nothing pressing on the surrounding brain. In these cases, separating normal from abnormal (“epileptic”) tissue may be more difficult. Removal of these abnormal areas to control seizures is defined as “epilepsy surgery.” Sometimes scars, tumors, or blood vessel abnormalities are removed incidentally while removing the abnormal tissue causing the seizures. As we continue our discussion of surgery, we are focusing on epilepsy surgery and not on tumor surgery.If there is a small, focal area of abnormality in the brain triggering seizures, it would seem far more logical to have that area removed surgically than to take anticonvulsant medication for a lifetime. Thus, surgery should be the treatment of choice for partial (focal) seizures if the focus is in a part of the brain that can be safely removed. While logical, this procedure is rarely undertaken. The brain has always been considered a sacred organ, one which should not be violated, and physicians have been reluctant to operate on the brain unless it is absolutely necessary. Patients were, and still are, afraid to have brain surgery. While elective surgery on most other organs is now considered routine, surgery on the brain is still considered by many to be a high-risk and frightening procedure, to be undertaken only as a last resort.With amazing technological advances that have made it possible to locate a seizure focus in more people with epilepsy and to distinguish normal from abnormal brains, surgery has become far safer. Recent advances have changed our whole approach to children and adults with difficult-to-control seizures. Still, epilepsy surgery should be considered only when the seizures have not responded to appropriate medications given in appropriate doses and when either the seizures or the medications are significantly interfering with the daily life of the patient.*151\208\8*