Principal Director & HOD, Neuro and Spine Surgery, Fortis Hospital, Shalimar Bagh, New Delhi
Part 7 of 9 in Diagnosis and Management of Brain Tumour
Epilepsy Surgery: Who Needs It and How It Helps
June 9, 2024
Epilepsy surgery is a distinct topic from brain tumour surgery, though the two overlap: some epilepsy is caused by a tumour or other lesion, and Dr. Gupta's department also treats epilepsy surgically.
Who actually needs epilepsy surgery
Not every epilepsy patient needs surgery. If epilepsy is adequately treated with the right doses of medication and remains controlled, and there is no lesion visible on MRI, surgery is not needed. Only intractable epilepsy (uncontrolled despite adequate medication) or epilepsy caused by a visible lesion warrants surgical evaluation. Any patient presenting with a seizure should have an MRI under the epilepsy protocol with contrast, since a standard CT scan can miss the small lesions responsible.
Benefits, accessibility, and children
Children benefit from epilepsy surgery at an early age when they are dependent on multiple medications: surgery reduces both the number of medications needed and their side effects. To make evaluation more accessible for patients abroad, an online epilepsy clinic can review a patient's medication history and MRI findings remotely, and the patient only needs to travel to India once epilepsy is confirmed to be intractable and a surgical workup is warranted.
This article is based on a Jivo Masterclass session conducted by Dr. Sonal Gupta, Principal Director & HOD, Neuro and Spine Surgery, Fortis Hospital, Shalimar Bagh, New Delhi. The article has been summarised with the assistance of an AI tool from the original masterclass recording. Watch the full Masterclass recording
Looking for a neurosurgery or brain tumour consultation? Get in touch with the Jivo team
This guide is based on a live Jivo Masterclass: Dr. Sonal Gupta taught doctors across Africa on June 9, 2024.
FROM THE LIVE Q&A
Moderator
Will children benefit from epilepsy surgery at an early age?
Dr. Sonal Gupta
Yes. If a child is dependent on multiple anti-epileptic medications, surgery helps by reducing both the number of medications needed and their side effects.
Frequently Asked Questions
A 19-year-old has been on epilepsy follow-up and medication for 10 years. The MRI is negative, but the EEG shows a slow-wave background. What is the next step?▼
This patient should be referred for a dedicated epilepsy workup.
After a complete resection of a cancerous mass, there is a void left in the brain. How does this void evolve during healing, and are there always neurological sequelae?▼
A cancer tumour can never be removed completely; microscopic cells are always left behind. Because these tumours cause significant surrounding brain swelling, the surgical cavity fills in quickly on its own, so the void itself is not a concern.
A 7-year-old girl presented with a two-week history of headache and vomiting that progressed over the last three days. MRI showed a well-defined left frontal lobe mass with a differential of metastasis versus high-grade glioma, and local doctors are recommending a frontal lobectomy. What would you recommend, and what are the likely outcomes?▼
Rather than an open frontal lobectomy, neuronavigation-guided keyhole tumour surgery using a surgical robotic system allows near-complete removal of high-grade tumours, improving survival, though high-grade tumours cannot be described as fully curable. This is typically followed by stereotactic radiosurgery and chemotherapy or immunotherapy depending on the biopsy, guided by genetic study of the tumour, which few centres worldwide perform routinely.
Is immunotherapy actually used in the treatment of brain tumours?▼
Yes. Genetic-based targeted immunotherapy is the latest advancement in brain tumour treatment.
For a 17-year-old patient showing several of these symptoms, what characteristics should guide a referral for further workup?▼
Symptoms alone do not distinguish a benign tumour from a malignant one; both can present the same way. A CT scan and MRI together can predict whether a tumour is benign or malignant with about 90% accuracy, though only a biopsy can confirm the diagnosis and grade. Any patient with these symptoms should be sent for an MRI.
Who needs epilepsy surgery?▼
Only patients with intractable epilepsy (uncontrolled despite adequate medication) or epilepsy caused by a visible lesion on MRI - not every epilepsy patient needs surgery.
Does epilepsy surgery help children?▼
Yes - especially those dependent on multiple medications, since surgery can reduce both the number of medications needed and their side effects.
In This Series: Diagnosis and Management of Brain Tumour
- 1.Brain Tumour
- 2.How Brain Tumours Are Classified: Benign, Malignant, Primary and Secondary
- 3.Brain Tumour Symptoms and Which Headaches Are Red Flags
- 4.Diagnosing Brain Tumours: CT, MRI and Beyond
- 5.Brain Tumour Surgery and Radiosurgery: Treatment Options Explained
- 6.Brain Tumour Surgery: Realistic Complication Rates and Recovery
- 7.Epilepsy Surgery: Who Needs It and How It Helps
- 8.Brain Tumours in Children and Newborns: Diagnosis and Management
- 9.Real Brain Tumour Cases: Weighing Surgery Against Radiosurgery