Resective procedures are the most common surgical approach for treating patients with pharmacoresistant focal epilepsy. The primary goal of these surgeries is to achieve complete seizure freedom by removing the area of the brain responsible for generating seizures—known as the epileptogenic zone.
When carefully selected and properly performed, resective surgery can offer significant improvement in quality of life, and in many cases, long-term seizure remission.
Surgical intervention for pharmacoresistant epilepsy is considered only after comprehensive diagnostic evaluation (see sections on diagnostic procedures and epilepsy surgery), and following a thorough assessment of potential risks and the patient’s individual expectations.
Depending on the type of epilepsy, the extent of the epileptogenic zone, and specific clinical characteristics of the patient, the medical team will recommend the most appropriate surgical approach from among the available options:
Lesionectomy involves the removal of abnormal, functionally altered brain tissue that is responsible for seizure generation. The most common lesions include tumors, vascular malformations, and areas affected by trauma or inflammation.
In some cases, where no clear structural abnormality is visible on imaging, but where preoperative testing—including invasive EEG—has confirmed a focal seizure origin, surgeons may perform a cortical resection to remove the involved brain region.
Another type of resective surgery is corpus callosotomy, which involves surgically severing part of the corpus callosum—the large fiber bundle that connects the two hemispheres of the brain. This procedure aims to interrupt the spread of seizures between the hemispheres.
This surgery is infrequently performed and is usually reserved for patients with severe developmental epilepsies such as Lennox-Gastaut syndrome, where resective surgery is not feasible and seizures are characterized by sudden falls and drop attacks, often leading to significant injury.
Functional hemispherotomy is a surgical approach used exclusively in early childhood for the treatment of very severe epileptic syndromes involving only one hemisphere of the brain. The procedure entails a functional disconnection of the affected hemisphere, but the brain tissue itself is left in place.
This approach helps prevent serious postoperative complications, which were more commonly observed with the previously used technique, anatomical hemispherectomy—a procedure that involved the complete removal of the affected hemisphere, and which is now largely obsolete.
Hemispherotomy is a surgical procedure reserved for the treatment of severe epileptic syndromes in young children, particularly when the seizures are believed to originate from extensive abnormalities affecting only one hemisphere of the brain.
In these severe epilepsy syndromes, children typically experience very frequent seizures along with developmental delays, affecting both cognitive and motor functions.
Hemispherotomy is indicated in cases where there is a large, unilateral brain abnormality, such as hemimegalencephaly or extensive cortical dysplasia, and aims to improve seizure control and overall development.
The exact course of epilepsy surgery depends on the specific type of procedure being performed. However, most surgeries follow a general sequence of steps:
The duration of the surgery varies based on the type and complexity of the procedure, but typically lasts several hours.
Patients are usually admitted to the hospital one day prior to surgery, with the procedure performed at the Department of Neurosurgery.
The postoperative hospital stay typically lasts around one week.
Recovery time varies from patient to patient. Sick leave is usually recommended for 1–3 months following surgery, depending on the individual’s health status and type of occupation. However, in some cases, a longer recovery period may be necessary.
The goal of epilepsy surgery is ideally complete seizure freedom. That said, results are highly individual, and seizure outcomes can vary.
Some patients may experience temporary mood changes (such as low mood or irritability) in the early postoperative period. It’s important to report any such symptoms to your treating neurologist as soon as possible. If needed, appropriate antidepressant therapy may be initiated.
Surgery has been shown to have a positive long-term effect on quality of life. Patients who become seizure-free often report improvements in:
After surgery, patients continue to be followed long-term and at regular intervals, either at the Brno Epilepsy Center or at their local neurology clinic. For patients from abroad or remote areas, we recommend attending at least one annual follow-up visit to monitor their condition and adjust treatment if necessary.
Epilepsy surgery carries similar risks to any other type of brain surgery, including infection, fever, and bleeding.
To minimize the risk of postoperative complications affecting memory, speech, vision, or motor function, you will undergo comprehensive preoperative evaluations as part of your preparation for surgery.
All potential risks and possible side effects will be thoroughly discussed with you by the physician managing your surgical care, ensuring you have a clear understanding before proceeding.
