Epilepsy surgery is a specialized neurosurgical procedure performed to control or eliminate seizures in patients whose epilepsy does not respond adequately to medications (drug-resistant epilepsy). The goal of surgery is to identify and remove or disconnect the area of the brain responsible for generating seizures, while preserving vital brain functions such as speech, movement, and memory.

• Indications: Surgery is considered when patients continue to have frequent or disabling seizures despite trying at least two appropriate anti-epileptic medications.
• Preoperative Evaluation: A comprehensive workup is done to precisely locate the seizure focus. This includes MRI brain, Video EEG monitoring, PET or SPECT scans, and sometimes Neuropsychological testing or Functional MRI to assess brain function.

Types of Surgery

• Temporal Lobectomy – Most common, involves removing the epileptogenic part of the temporal lobe.
• Lesionectomy – Removal of a specific lesion such as a tumor, scar, or malformation causing seizures.
• Corpus Callosotomy – Cutting the fibers connecting the two hemispheres to prevent seizure spread.
• Hemispherectomy / Hemispherotomy – Removal or disconnection of one cerebral hemisphere (in severe, one-sided epilepsy).
• Vagus Nerve Stimulation (VNS) or Responsive Neurostimulation (RNS) – Implantable devices that help reduce seizure frequency in non-resectable cases.