Texas Children’s offers novel surgical treatment for patients with epilepsy

Imagine being a parent whose child suffers from dozens or even hundreds of seizures a day. When medications don’t seem to work, surgical treatment is often the next option. Ranked No. 4 in the nation in neurology and neurosurgery by U.S. News & World Report, Texas Children’s is one of few centers in the world to offer a new innovative surgical approach that has the potential to benefit children with certain types of epilepsy.

Unlike traditional open hemispherotomy surgery – which involves a large question mark shaped incision on the top and side of the head to disconnect the right and left hemispheres of the brain – the hospital’s new, minimally invasive endoscopic procedure is performed through a much smaller opening in the head that translates to less blood loss, less postoperative pain, less discomfort and swelling, and a quicker recovery.

Hemispherotomy surgeries are typically done when seizures are proven to be arising from one side (hemisphere) of the brain. Certain surgical cuts are made in the “bad” side of the brain to completely disconnect it from the unaffected side of the brain. Seizures then cannot spread from the bad side to the good hemisphere.

“When patients have multiple seizures every day for years, every day and every week of seizure freedom is a very big deal for these children and their families,” said Texas Children’s neurosurgeon Dr. Sandi Lam. “Patients who reach the three, six or 12-month and longer time points of being seizure free after undergoing this procedure are all considered important milestones and a significant, ongoing measure of success.”

Three months ago, Lam performed Texas Children’s first endoscopic hemispherectomy surgery on an 11-year-old boy who had been experiencing five to six seizures per day despite taking many different medications to control his seizures. While the unpredictability and the frequency of his seizures had been negatively impacting his daily life, Lam says her patient has so far been seizure free for three months after undergoing this minimally invasive endoscopic procedure.

“Since his whole brain isn’t busy seizing all the time now, he is able to use the good side of his brain more to its potential,” Lam said. “On an outpatient basis, he has been working with therapists and physical medicine and rehabilitation specialists to make strides during his recovery. In fact, he is able to do and learn more than he ever has before.”

As part of the Comprehensive Epilepsy Surgery Program at Texas Children’s, this new type of surgery option fits with the program’s trend toward minimally invasive surgery and enhanced recovery, and expands the offering of our multidisciplinary pediatric epilepsy surgery program, where we focus on choosing the best surgery tailored for each individual patient at the right time.

“We are very excited about this new development,” said Texas Children’s Neurosurgery Chief Dr. Howard Weiner. “This new surgical offering at Texas Children’s highlights another reason why we as a division of neurosurgery and as an institution are the destination for high-quality, world-class innovative and attentive care for children.”

Dr. Daniel Curry, director of the functional and epilepsy surgery service at Texas Children’s, added, “This used to be one of the biggest surgeries that we do in pediatric neurosurgery. Dr. Lam has worked on it extensively, perfecting the technique to safely perform the surgery with the help of an endoscope camera through a much smaller incision in the head, making the process of recovery from surgery so much easier on the children. This marks a huge paradigm shift in the way we do surgery.”

Lam says this type of surgery is quite novel, as it has reportedly been done in only two other centers in the world – one in India (All India Institute of Medical Sciences, New Delhi) and one in Detroit (Children’s Hospital of Michigan). Since December 2017, Texas Children’s neurosurgery team has performed four more of these endoscopic hemispherotomy surgeries.

“The outcomes have been so positive thus far – better than we thought possible,” Lam said. “Patients are being referred to Texas Children’s for this minimally invasive option, and we have planned more of these surgeries for patients who are good candidates for this procedure. We are keeping careful track of the results, and we will keep on innovating to do better for our patients. We are so excited to be able to have this novel treatment option as part of our epilepsy surgery program.”