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Our multidisciplinary team is comprised of experts in Epileptology, Adult and Pediatric
Neurosurgery, Intra-Operative EEG Techniques, Neurology, Neuropsychology, and
Neurophysiology. Any patient with medically intractable seizures or with structural
lesions involving eloquent brain regions may be considered for invasive monitoring.
Preoperative Evaluation
Before this process, tests are performed to determine the following:
- What type (or types) of seizures?
- Where do they originate from?
- If from within one side of the brain, which lobe does the seizure(s) originate from?
- What is the patient’s current level of personal and social functioning?
- Will speech and/or memory be affected by surgery?
- Are the seizures due to a distinct structural lesion (tumor, cortical dysplasia, mesial
temporal sclerosis)?
- These questions are answered in Phase I and Phase II evaluations:
Phase I
- Cognitive and functional assessment-neuropsychological testing
- Video EEG recording of seizures
- Magnetic resonance imaging with a dedicated epilepsy protocol and expert
neuroradiologists
- PET Scan
- SISCOM (Ictal SPECT subtracted from interictal and co-registered to MRI)
- WADA testing for language and memory localization
- A visual fields exam, if needed
Phase II
- Invasive monitoring with depth or subdural grid/strip electrodes.
- Cortical stimulation for further language, memory, and motor functional mapping
The information obtained in Phase I and II evaluations is reviewed by the
multidisciplinary epilepsy team
to determine if epilepsy surgery is a reasonable treatment option.
This constitutes Phase III.
Surgical alternatives include:
- Standard temporal lobectomy
- Tailored temporal lobectomy
- Selective amygdalohippocampectomy
- Selective cortical resection and lesionectomy
- Corpus callosotomy
- Hemispherectomy (anatomic, functional, tailored)
- Multiple subpial transections
- Vagus nerve stimulation
- Microsurgical resection of brain tumors and vascular malformations
- Gamma
Knife Surgery (Radiosurgery)
Epilepsy surgery is facilitated by the use of state-of-the-art techniques and equipment
including the ultrasonic
surgical aspirator, a variety of image-guided microscope navigation systems, and fMRI.
Following surgery, Phase IV is comprised of:
- long-term follow-up,
- neuropsychological testing and counseling, and
- (if needed) physical, occupational, vocational and speech therapy.
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