- Epilepsy Surgery
- Pain Relief Surgery
- Trigeminal Neuralgia Surgery
In some cases of epilepsy, surgery is performed to control the seizures that are not manageable
with medications. Although various anti-epileptic drugs are available but sometimes all the drugs
remain ineffective in controlling the seizures. Also, sometimes the cause of epilepsy can only be
treated by surgery. So in all these cases, surgery becomes inevitable to provide quality and fear
free life to the patient. There are many types of epilepsy surgery and the choice depends upon
type, severity and originating point of epilepsy. The main forms of surgery are:
- Intra-operative Monitoring: In this technique, a small incision is created in the scalp to
remove a piece of bone along with dura. Now catheter and other specialised instruments
are inserted into it. During pre-operative evaluation, the actual size, location and type of
seizure are analysed. This greatly helps to completely remove the damaged part during
surgery. After the completion of surgery, the bone and dura are again fixed into their
place and stitches are applied to the scalp.
- Amygdalohippocampactomy: This is one of the most successful and relatively easier
procedures that are performed to treat Mesial Temporal Sclerosis with consistent results.
- Multiple subpial transections: This technique is employed in situations where it seems
to be impossible to remove the damaged part causing seizures. A series of cuts are
made around the damaged part in an attempt to separate the seizure causing part from
the surrounding area. Thus the movement of seizure across the brain is stopped.
Corpus callosotomy: This method aims at dividing the corpus callosum into two parts
i.e., hemisphere. The part containing the seizures is separated from the other part. This
helps in controlling the spread of seizure into other part of the brain and thus reduces the
severity of the seizure.
Hemispherectomy: It is a major surgery that involves the removal of cortex (outer
covering) of one of the hemisphere to limit the spread of seizures. This is done in
conditions where one-half of the brain is damaged
Pain Relief Surgery
Surgery is often considered as a last option to get immediate relief from pain. There are a
variety of pain relieving surgeries that may give temporary or permanent relief to the patient.
- Cordotomy: It is the most common method of treatment of pain. It separates the spinal
cord nerve fibers from travelling towards the brain. It may be done through a
laminectomy or percutaneously. The fibers may be on one or both side of spinal cord.
The sense of pain and temperature are affected by cordotomy.
- Mesencephalotomy: This method involves using any structure in the midbrain,
especially spinothalamic tract or Quinto-thalamic tract to relief pain. It is a useful method
for treating unbearable pain. It is also helpful in reducing harmful head and neck pain.
- Sympathectomy: The sympathectomy is a useful method for reducing long-term pain.
In this procedure, the nerves in the sympathetic nervous system are surgically removed.
This increases the flow of blood and reduces pressure. This technique is also useful in
treating the heavy sweat produced in the palms or underarms or face.
- Myelotomy: The surgical process which involves the separation of midline transverse
fibers of the spinal cord is known as myelotomy. This reduces the pressure in the spinal
cord. Hence the unbearable pain is almost reduced.
- Cingulotomy: It is a useful method to reduce pain in severe psychiatric patients. The
nerve fibers related to emotions and motivations are destroyed. The surgery reduces or
eliminates the suffering of the patient. It does not affect the mental abilities of the patient.
Trigeminal Neuralgia Surgery (Microvascular
Initially, treatment for trigeminal neuralgia includes medications (anti-seizure drugs such as
Carbamazepine or gabapentin or muscle-relaxing agents such as baclofen etc. or
complementary approaches (like meditation, yoga, acupuncture, low impact exercise etc.). But
as it is a progressive disorder, medications soon become ineffective or may start showing side
effects. In such cases, neurosurgical procedures like Microvascular Decompression should be
considered that relieve the nerve pressure.
Microvascular decompression is a highly effective surgical method that mainly addresses the
source of neuralgia by treating neurovascular disabilities associated with spasm and facial pain.
Method of Microvascular Decompression
The surgery is performed under general or local anaesthesia and involves relocating or
removing blood vessels that are in contact with the trigeminal root. Through an incision behind
the ear on the side of pain, surgeon enters the endoscope through a small hole in the skull. Any
artery that is in contact with the trigeminal nerve is moved away from the nerve, and a pad is
placed between the nerve and the arteries. In case, a vein is compressing the nerve, it may be
removed as well. In some rare cases, a part of the trigeminal nerve (neurectomy) may be cut
during this procedure if arteries aren’t pressing on the nerve.
This provides relief to the patient from the symptoms of neuralgia. A follow-up after 2-3 months
is usually required after surgery
Advantages of Microvascular Decompression
- Successfully eliminates or reduces pain in most of the cases
- Provides rapid & long-term relief from pain
- Is a safe and flexible technique
- Low risk of recurrence
Risks of Microvascular Decompression
The procedure does have some risks that may include any of the following:
- Decreased hearing
- Facial weakness
- Facial numbness
- Nerve damage
- Stroke etc.
Microvascular decompression can successfully eliminate or reduce pain in most of the cases,
but pain can recur in some people. Most people who have this procedure have no facial