Type of Surgery
Last updated: 02/17/2009
The candidate for any type of epilepsy surgery will have had a wide range of tests prior to surgery. These include electroencephalography (EEG), in which electrodes are placed on the scalp, on the brain surface, or within the brain to record...
electrical activity. EEG is used to attempt to locate the focal point(s) of the seizure activity.
Several neuroimaging procedures are used to obtain images of the brain. These may reveal structural abnormalities that the neurosurgeon must be aware of. These procedures may include magnetic resonance imaging (MRI), x rays, computed tomography (CT) scans, or positron emission tomography (PET) imaging.
Neuropsychological tests may be done to provide a baseline against which the results of the surgery are measured. A Wada test may also be performed. In this test, a drug is injected into the artery leading to one half of the brain, putting it to sleep, allowing the neurologist to determine where language and other functions in the brain are localized, which may be useful for predicting the result of the surgery.
Corpus callosotomy (or less frequently, callotomy) is a surgical procedure that disconnects the cerebral hemispheres, resulting in a condition called split-brain.
Most modern callosotomies involve only the anterior portion of the corpus callosum, reflecting the fact that the frontal and temporal lobes are the most commonly involved in the genesis of seizures. The deficits from this modified procedure are milder; side-effects have not been found in some patients (although it is very unlikely that none exist).
The corpus callosum is usually severed in order to stop epileptic seizures. Once the corpus callosum is cut, the brain has much more difficulty sending messages between the hemispheres. Although the corpus callosum is the largest white-matter tract connecting the hemispheres, some limited interhemispheric communication is still possible via the anterior commissure and posterior commissure. When tested in particular situations, it is obvious that information transfer between the hemispheres is reduced.
Select comparative data from 1999 to 2006 include a decrease of 14 percent in the number of neurosurgeons in private practice and a decrease of 13 percent in the number of neurosurgeons in solo practice.
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