How long does epilepsy surgery last?

The duration of surgery can be quite variable depending on the type of procedure being performed. VNS implantation may last an hour or less. sEEG typically takes 2 hours. Temporal lobectomy may last 3 hours. Functional hemispherotomy can last 4 hours or even more. These are all general estimates and depend on a number of factors unique to each patient.Remember that about an hour should be added to the beginning of any procedure as well as to the back end to account for time to perform anesthesia and transport.

Will my head be shaved?

Almost never do we shave the head. There is no evidence that shaving the head decreases the risk of infection. In almost every case, we perform hair-sparing procedures.

How long will the incision be?

The incision may be very short (eg. 3 mm stab incisions for sEEG) or potentially longer (eg. hemispherotomy), however all incisions lines are made behind the hair line and thus should be well-hidden in the hair. For most patients, it is difficult or impossible to discern any scar after surgery. Men with receding hairlines may have a visible scar after surgery.If you are prone to keloid formation, your scar may be thicker and more visible.

Will you remove part of my skull?

Yes, a craniotomy does involve making a small window in the bone of the skull, but this will typically be secured back in place at the end of the surgery either with stitches or small metal plates.

How painful is epilepsy surgery?

The brain itself lacks nerve endings and so operating in the brain does not cause pain.Most patients do experience a little soreness at the site of the incision for about 48-72 hours after surgery.Sometimes the chewing muscle(eg.temporals muscle) can also feel sore after surgery. However most patients tolerate craniotomy with relatively minimal pain. Our team will be aggressive and proactive about treating pain. In young children or in adults with difficulty communicating, high blood pressure, tachycardia, and tachypnea can be used as surrogate markers of pain to guide analgesic administration.

What should we expect after surgery?

After most surgeries, patients will be admitted to the intensive care unit (ICU) for at least 24 hours and sometimes for several days. After select surgeries (eg. hemispherotomy), patients will wake up with a small tube called an external ventricular drain. Very often, a postoperative CT scan will be performed soon after completion of surgery. Nurses will often check patients every hour or more frequently to assess neurological status. If you are coming for a planned 2-stage surgery(eg.sEEG or subdural grids followed by definitive resection) you may need to plan on staying in the hospital longer because we need to capture several seizures in order to get useful information from the invasive electrodes.Before leaving the hospital, patients will be evaluated by physical therapy and in some cases may need some inpatient or outpatient physical/ occupational therapy.

Can we talk to other patients and/or families who have been through similar surgery?

Absolutely! In fact, we encourage this as it gives patients and families an excellent understanding of the whole process. As one of the busiest surgical epilepsy programs in the state, we now have a number of patients for every type of surgery. We are happy to connect you with other patients at your request.

Do I need medical clearance / preoperative lab studies to undergo epilepsy surgery?

The surgeon will sometimes request basic labs (eg. blood count and coagulation studies) as well as a letter of surgical clearance from the patient's primary care physician. Further studies like chest x-ray and EKG may be required on a case-by-case basis. If you have major health problems unrelated to your epilepsy (eg. heart trouble, chronic obstructive pulmonary disease), we may ask for surgical clearance from a specialist. Young otherwise healthy children may not need any presurgical testing at all.

Do I need COVID test?

All hospitals in NJ continue to require COVID testing prior to surgery; typically COVID testing should be performed 1-3 days before the surgical date. We ask that patients call the hospital a week before scheduled surgery to inquire about COVID testing requirements.

How dangerous is epilepsy surgery?

According to recently published literature, the risk of death from epilepsy surgery is < 1%. The risk of some other serious complication (eg. infection, weakness, difficulty speaking, visual field deficit) depends on the area of brain being operated, but is generally quite low. Repeated studies show patients generally over- estimate the risks of surgery and underestimate the benefits.

What preparations do I need to make the night before surgery?

Patients are told to remain NPO after midnight on the night before the day of surgery. NPO means “nothing by mouth” and includes food and drink. If you eat breakfast or drink a cup of coffee before coming to the hospital for surgery, your surgery will be cancelled! Patients ARE ALLOWED however to take their anti-seizure medications (ASMs) with a small sip of water at any time before surgery including the morning of surgery.

Should I bring my medicines to the hospital with me?

No, this is typically not necessary and most of the hospitals have rules against patients taking outside medications while admitted. Having said that, if you are on a very rare medicine or in a clinical trial, it is reasonable to bring a short supply with you. Always consult with your nurse before taking any medication.

I am on a blood thinner. Can I continue taking this throughout my surgery and hospital stay?

No. In almost every case, we insist that patients stop blood thinners before surgery. Aspirin should be stopped one week prior to the day of surgery. If you are on another type for blood thinner (eg. Heparin, Lovenox, Plavix, Eliquis, Brilinta), you will need to meet with the doctor prescribing this medicine and get directions about stopping it before surgery and restarting it afterwards.

When should I arrive to the hospital on the day of surgery?

Most patients are expected to arrive to the hospital at least 2 hours before the time of surgery. We recommend calling directly to the hospital presurgical services department. This is also a good resource to check the most recent COVID testing requirements as these continue to change and are particular to each hospital. The numbers are listed below for the various centers where we perform epilepsy surgery.

When I go home after surgery, is there anything I should look out for?

If you experience any significant redness or leakage of fluid from the incision, it is important to immediately call your doctor or simply come to the emergency department (ED). A fluid collection will sometimes develop within the scalp near the incision. As long as this fluid collection is soft and there is no fluid leaking from the incision, it is typically very safe and will recede over time with no further treatment. If you are experiencing any fevers, chills, neck pain or increased headache, lethargy, confusion, altered mental status, weakness, or change in your neurological exam, please call us or go to the ED.

How do I care for the incision after surgery?

In almost every case, the surgeon will use resorbable suture material that will eventually dissolve and fall out. This is normal. Most patients will be allowed to shower or bathe 48 hours after surgery. Baby shampoo is often a good option for at least the first two weeks after surgery. Pad-dry area of incision with a towel. Keep incision clean and dry in between bathing. Soaking the incision under water for prolonged periods of time or swimming in a pool/lake is discouraged for the first month after surgery. Use of creams on the incision should be avoided in the first month.

Should I take any special medicines after surgery?

All patients will get 24 hours of antibiotic therapy after surgery. Sometimes, a 10-14 day steroid taper may be given to patients after surgery. All patients will remain on their home anti-seizure medicines (ASMs) after surgery. Do not discontinue any of your anti-seizure medicines without first consulting with your neurologist/epileptologist. Typically, these medicines can be weaned off 3-6 months after surgery once a post-operative EEG has been done. The goal of surgery is palliation or complete resolution of seizures, and while many patients will achieve this result without continuing anti-seizure medicines, other patients will need to stay on anti-seizure medicines to maintain good control.

If the patient has a seizure in the early postoperative period, does this mean that epilepsy surgery was unsuccessful?

Not necessarily. Following certain types of surgeries, early postoperative seizures can occur without having a significant impact on long-term seizure control.

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