Pediatric Epilepsy Surgery

For some children with epilepsy, surgery may be the most effective treatment option when their seizures don’t respond to medication or diet changes. The goal of epilepsy surgery is to find and treat the exact part of the brain where the seizures originate — to stop them, make them less severe, or help reduce seizures in cases where there’s no clear cause, such as with generalized epilepsy. At Boston Children’s Hospital’s Epilepsy Center, we specialize in diagnostic procedures, surgical options, and advanced neuromodulation therapies designed to better understand and treat your child’s seizures. Our goal is to deliver the least invasive, most effective, and safest treatment for your child to improve their quality of life.

At Boston Children’s, we take a multi-step, collaborative approach to treating epilepsy. We use advanced diagnostic tools such as high-resolution MRI, long-term monitoring, functional and metabolic testing and imaging, and invasive monitoring via stereo EEG (sEEG) — a surgical procedure that places electrodes in the brain through small holes in the skull — to pinpoint the area of the brain producing your child’s seizures and safeguarding key brain functions that must be preserved. Our multidisciplinary team of epilepsy surgeons, epileptologists, neuroradiologists, neuropsychologists, nurses, and social workers meets regularly to discuss each case and patient individually; this allows us to weigh all options and create a personalized treatment plan for your child.

If your child needs epilepsy surgery but the exact location of their seizures (seizure focus) is suspected but not confirmed using non-invasive testing, we often take a two-stage approach.

The first stage involves sEEG, where electrodes are placed in the brain to precisely locate the seizures and areas of the brain critical to key functions. Monitoring can take a week or so to ensure accuracy, so your child will stay in our Epilepsy Monitoring Unit (EMU) during the process.

In the second stage, we remove the electrodes and perform the necessary surgery — such as laser ablation or resection — in one session. This approach helps avoid the need for multiple rounds of anesthesia and hospital stays, making the treatment process less stressful for your child and your family. Unlike the traditional approach, which requires one surgery to remove the electrodes and a separate surgery to treat the epilepsy, our method combines everything into a single procedure.

Boston Children’s Epilepsy Surgery Program offers a variety of personalized treatment options to help manage your child’s seizures. Our approaches range from minimally invasive procedures to more extensive surgeries and neuromodulation treatments, each carefully chosen to provide the best possible outcome based on your child’s specific needs.

Surgery

We provide several surgical options to treat your child’s epilepsy, from minimally invasive treatments like laser ablation to more extensive surgeries such as hemispherotomy. These include:

• Focal resection: If your child’s care team can pinpoint the specific area of your child’s brain that is over-firing and causing the seizures (a “focal point”), your child may be able to have surgery to remove the abnormal brain tissue without harming neighboring brain areas. This procedure, called “resective” surgery, can often stop the seizures entirely, allowing many children to function normally afterward.
• Laser ablation: Laser interstitial thermal therapy (LITT) is a minimally invasive approach to heating and ablating the seizure focus. LITT requires precise localization of the seizure focus, often done using sEEG intracranial monitoring. This allows our epilepsy surgery team to assess the optimal surgical option for each patient. sEEG and LITT are exceptionally well suited for deep seizure foci in the brain not readily accessible by other methods.
• Corpus callosotomy: Corpus callosotomy involves cutting a major fiber bundle that connects the two halves (hemispheres) of the brain. This can prevent seizures from spreading from one side of your child’s brain to the other by cutting off communication between the two hemispheres. Corpus callosotomy is particularly effective for children who experience severe “drop attacks” in which they lose muscle tone. While seizures won’t usually go away, in most cases, they become less frequent, milder, and less disabling.
• Hemispherotomy: A hemispherotomy involves disconnecting one half (hemisphere) of the brain. It may be used if seizures are coming from a broad area of a single hemisphere. Hemispherotomy can be very effective in controlling seizures; however, it can cause serious side effects in older children who have relatively normal function in the affected hemisphere. Side effects include motor, peripheral vision, and language impairment, so the risks must be weighed against the severity of the epilepsy symptoms themselves. For younger children, or when the affected hemisphere is already weakened by the disease, recovery tends to be easier with fewer side effects.

Neuromodulation

Through neuromodulation techniques such as nerve and brain stimulation, we help manage seizures by using electrical or magnetic stimuli to modify brain activity, avoiding more invasive surgery. Neuromodulation doesn’t usually provide a complete cure, but can significantly reduce seizures when a specific seizure focus doesn’t exist or can’t be safely targeted with resection or LITT. Types of neuromodulation techniques include:

• Transcranial magnetic stimulation (TMS) uses a strong magnet on a child’s head to create changing magnetic fields. These fields produce tiny electric currents in the brain, which lower brain activity. TMS is actively used at Boston Children’s to map motor and speech cortical areas before brain surgery and can sometimes be used as a treatment for epilepsy.
• Responsive neurostimulation (RNS) involves a surgically implanted device with brain electrodes connected to a neurostimulator, similar to a cardiac pacemaker, that’s placed in the skull to provide closed loop, or responsive, electrical stimulation based on recorded EEG signals to stop the seizure event.
• Deep brain stimulation (DBS) involves a surgically implanted device that includes thalamic brain electrodes connected to a neurostimulator under the skin of the chest wall or abdomen, which provides open loop, or regular, electrical stimulation to reduce seizures.
• Vagus nerve stimulation (VNS) involves a small neurostimulator surgically placed under the skin of the chest wall and connected to the vagus nerve in the neck. The neurostimulator sends a regular electrical signal to the nerve and nervous system, which influence the brain. It also comes with a magnet to provide extra signals when needed and a sensor that detects changes in heart rate, which may indicate a seizure and trigger an additional signal.