For individuals living with epilepsy, managing seizures is a crucial aspect of maintaining their quality of life. While many patients achieve seizure control with anti-seizure medications (ASMs), about 30-40% of individuals have drug-resistant or medically refractory epilepsy—a form of epilepsy that cannot be controlled by traditional medications (Hakami, 2021). For these patients, alternative treatment options such as surgical interventions may be considered. Surgical interventions have evolved significantly over the years, providing life-changing benefits for many individuals who do not respond to medication alone. Brain surgery for epilepsy aims to either remove or alter the brain tissue responsible for seizures to ultimately reduce or eliminate seizure activity. 

History and Evolution of Epilepsy Surgery 

Surgical interventions for epilepsy have existed for more than a century. One of the earliest recorded epilepsy surgeries was performed in the late 19th century when neurosurgeons began identifying seizure foci (areas of the brain responsible for seizure activity) and attempting surgical removal (Engel, 2016). However, it wasn’t until the 20th century, when technological advancements in neuroimaging and electrophysiology became common, that epilepsy surgery became a more viable and safer option. The development of electroencephalography (EEG) and magnetic resonance imaging (MRI) allowed for more precise localization of seizure activity, increasing surgical success rates and reducing risks. 

Over time, various surgical techniques have been developed, each tailored to a patient’s specific condition. Today, epilepsy surgery is a well-established treatment option for carefully selected individuals, with some procedures offering seizure-free outcomes in over 70% of cases (Englot et al., 2018). 

Types of Epilepsy Surgery 

Brain surgery for epilepsy can be categorized into several types, each with distinct mechanisms and outcomes. Epilepsy surgery can be divided into three broad categories: diagnostic, resective/ablative and neuromodulation. The type of surgery a patient undergoes depends on the location of their seizures, their overall health, and how well they respond to other treatments. 

Diagnostic Procedures 

Before performing surgery, doctors often need to determine exactly where in the brain the seizures are coming from. To do this, they use specialized diagnostic procedures: 

• Stereoencephalography (SEEG): A minimally invasive procedure where tiny electrodes are inserted into the brain to track seizure activity in real-time. 

• Craniotomy for Subdural Grids/Strips: A procedure where a small section of the skull is removed, and electrodes are placed directly on the brain’s surface to help pinpoint where seizures originate from. 

For some patients, diagnostic procedures may not be necessary if the seizure focus is already well-defined through non-invasive imaging, such as temporal lobe epilepsy where surgery can proceed directly (Wiebe et al., 2001).