Temporal lobectomy, or removal of the temporal lobe, is less commonly performed for temporal lobe epilepsy. It is appropriate for many patients whose temporal lobe seizures are caused by conditions other than mesial temporal sclerosis (cortical malformation, scar, tumor, etc).
Lesion resection is often the preferred operation for patients with a lesion or abnormality visualized on CT or MRI, such as scar, old hemorrhage, tumor, or a cortical malformation that resides outside the temporal lobe. For many patients, simply removing the lesion may alleviate their seizures. Intracranial grid recordings to map seizure onset and brain functions may be appropriate for some patients.
Customized neocortical resection is a highly tailored procedure that may be unique to a particular patient. It is often outside the temporal lobe. Patients may or may not have an area of abnormality on brain imaging studies. Surgery is typically performed with intracranial grid seizure recording and functional brain mapping.
Hemispherectomy is a relatively radical procedure that involves the removal of an entire cerebral hemisphere to control seizures. The procedure is most appropriate for severe and refractory epilepsy in infants and children. Candidates for hemispherectomy may have a congenital condition that affects one hemisphere or an acquired disease such as Rasmussen's encephalitis. Depending on circumstances, the neurosurgeon may perform a total anatomic hemispherectomy (complete removal of the cortical hemisphere sparing deeper structures) or a modified hemispherectomy (partial removal of cerebral hemisphere with disconnection of the remainder of the hemisphere from other brain structures).
Hypothalamic hamartoma resection is performed under the auspices of Barrow's Hypothalamic Hamartoma Program, a multidisciplinary program for treating children and adults with this relatively uncommon disorder. The first such program in the U.S., Barrow's Hypothalamic Hamartoma Program is currently one of the most active programs in the world for the treatment of this lesion.
Multiple subpial transection is performed to improve seizure control when the brain tissue causing the seizures cannot be removed because it serves a critically important function such as speech. The region is "scored" with a probe to disrupt lateral (side-to-side) nerve fibers. The fibers that travel deep, which are more important for local tissue function are spread.
