Epilepsy Surgical Treatment
In approximately one third of patients, anticonvulsant medications cannot adequately control seizures. When seizures cannot be controlled with medication alone, Hoag offers the latest techniques in surgical intervention. Surgery can eliminate seizures in the majority of patients and reduce seizures in most of the remainder. Various testing is done to help determine where seizures are starting in the brain. This may include implantation of electrodes for intracranial monitoring. Once the location causing seizures has been determined, Hoag neurosurgeons utilize state-of-the-art neuronavigational technology and sophisticated magnetic resonance imaging techniques to precisely reach and treat the seizure areas safely.
Open Resection Surgery
Using state-of-the-art intraoperative navigation and 3D imaging/augmented reality tools, Hoag’s Pickup Family Neurosciences Institute is one of the few to offer minimally invasive surgical options for patients who require open surgery. Temporal lobectomy and focal resections are the standard of care for certain types of disorders causing epilepsy with decades of proven data regarding safety and efficacy.
Minimally Invasive Surgery
- Laser Interstitial Thermal Therapy (LITT)
Dr. Vivek Mehta, neurosurgeon at the Hoag Pickup Family Neurosciences Institute, along with epileptologists Dr. David Millett and Dr. James Park, have partnered to bring this revolutionary treatment option to cure the most difficult form of epilepsy.
LITT is a technique used to selectively ablate areas of the brain that cause seizures. This new minimally invasive technique allows the surgeon to precisely target and ablate the source of the seizures using real time MRI guidance. As compared to traditional open surgery, which would result in a longer hospital stay and leave a large surgical scar, this technique allows patients to go home either the same day or the next day with just one small stitch. The result is much faster healing and recovery and a significantly shorter hospital stay.
Patients who have benefited from this technology have a 87% seizure freedom rate compared to the national average of 61%.
- Stealth Autoguide Robot
The Pickup Family Neurosciences Institute at Hoag became one of the first hospitals in the nation to obtain and use the Medtronic Stealth Autoguide Robotic Platform to treat epileptic seizures and the first hospital in the world to perform minimally invasive brain biopsy using this technology.
The Stealth Autoguide Robot uses a small pinpoint hole through which neurosurgeons can place electrodes or biopsy needles precisely in the brain to diagnose or treat epilepsy, cancer or other neurological conditions. Without this tool, these procedures typically involve shaving large portions of the scalp, making larger incisions and removing pieces of skull to expose the brain for surgery.
The highly advanced surgical tool replaces open cranial surgery for certain patients and greatly increases accuracy and patient recovery. The device can be used for a range of neurological conditions that require precision guidance for placement of diagnostic electrodes, biopsy or targeted laser ablation.
- Vagal Nerve Stimulation
VNS is a minimally invasive, same-day surgery and is one of the first FDA approved surgical therapies for epilepsy surgery. It is used for patients whose seizures are resistant to antiepileptic medications. Implanted under the skin below the left collarbone, the VNS generator delivers intermittent nerve stimulation to the vagus nerve to effectively block seizures from occurring in a good percentage of individuals.
- Responsive Neurostimulation (RNS) Therapy
RNS uses an implanted device to detect seizures and stimulate the brain to stop seizures, similar to how a pacemaker detects and treats abnormal heart rhythms.
The patient’s brain waves are constantly monitored by the device and select data is uploaded into a system, allowing the epilepsy specialists to review the information and finely tune the device for better seizure detection and treatment.
- Deep Brain Stimulation (DBS)
Having been used in Europe for over a decade, DBS was approved in the US in 2018 and delivers controlled electrical pulses to a location inside the brain which is involved in seizures. The system consists of a pulse generator (IPG) implanted under the skin of the upper chest, and two leads implanted in the brain. The Medtronic DBS System for Epilepsy helps reduce the frequency of seizures in epilepsy patients who have frequent, disabling, partial-onset seizures and have not responded well to antiepileptic medications.