When is a lesionectomy offered?

Structural abnormalities in the brain may cause seizure activity. These lesions can be congenital or acquired. Congenital lesions include malformations of the brain, such as cortical dysplasia (caused by abnormal brain folding or cellular migration during fetal brain development) or vascular malformations (arteriovenous malformations, angiomas and cavernous malformations). Acquired lesions include brain tumors (ganglioglioma, DNET and astrocytomas are a few examples), brain injuries and infarctions/strokes.

When these structural lesions cause seizures, removal (resection) of the lesion may result in relief of seizure activity.

After a thorough non-invasive evaluation by our comprehensive epilepsy center using tests such as high-resolution MRI, functional MRI, EEG and Video-EEG analysis, MEG, SPECT and PET scans, a surgical plan may be offered including a lesionectomy. During a lesionectomy, the neurosurgeon will use cutting-edge MRI-guidance, or in some cases, intraoperative MRI, to target and remove the lesion responsible for the seizures. The surgical plan is highly tailored to the patient, the lesion, and the lesion location.

Lesionectomy: what to expect

  • In a typical lesionectomy surgery, the child is admitted to the hospital the morning of surgery.
  • The operation is performed under general anesthesia, and usually takes several hours.
  • A temporary window through the skull is made by the neurosurgeon.
  • The lesion is removed using special instrumentation and techniques.
  • The temporary bone window is replaced and secured, and absorbable sutures are used to close the incision.
  • Typically, recovery includes an overnight stay in the Pediatric Intensive Care Unit, followed by two to three days on the neurosurgery/neurology ward on the 12th floor.
  • Often a postoperative MRI is obtained while in the hospital, and follow-up visits include a check with the neurosurgeon at 1-2 weeks after discharge, and at 6-month intervals thereafter.

Lesionectomy image (before / after)

Lesionectomy image (before / after

This 15 year old boy suffered from seizures caused by this cavernous angioma/malformation in the base of the left temporal lobe (white arrow, left image). The lesion was removed (white arrow, right image), and he remains free of seizures since the surgery.

Selected publications and abstracts from our physicians

  1. Titus J, Lee A, Kasesbah A, Thio LL, Stephenson J, Steger-May K, Limbrick DD, Smyth MD.  Health-related quality of life before and after pediatric epilepsy surgery: The influence of seizure outcome on changes in physical functioning and social functioning. Epilepsy and Behavior, Jun 27;27(3):477-483, 2013.
  2. Mohammed H, Steger-May K, Kaufman C, Weisenberg J, Munro B, Rothman SM, Grubb R, Limbrick DL, Smyth MD: Impact of epilepsy surgery on seizure control and quality of life: A 26-year follow-up study.  Epilepsia 53(4):712-720, 2012.
  3. Kasasbeh A, Steger-May K, Yarborough C, Limbrick DL, Smyth MD.  Characterization of the supplementary motor syndrome after medial frontal lobe resections in pediatric epilepsy surgery.  Neurosurgery, 70(5):1152-68, 2012.
  4. O’Brien DF, Farrell M, Delanty N, Traunecker H, Perrin R, Smyth MD and Park TS. The Children’s Cancer and Leukaemia Group Guidelines for the Diagnosis and Management of Dysembryoplastic Neuroepithelial Tumours. British Journal of Neurosurgery, 21 (6):539-49, 2007.
  5. Chicoine MR, Singla A, Dacey RG, Zipfel GJ, Rich KM, Dowling JL, Leonard JR, Smyth MD, Santiago P, Leuthardt EC, Limbrick DD: Implementation and Preliminary Clinical Experience with the Use of Ceiling Mounted Mobile High Field Intraoperative Magnetic Resonance Imaging. Presented to the 5th Annual World Congress for Brain Mapping and Image Guide Therapy, Los Angeles, CA Aug 2008.
  6. Lee BCP, Leonard JR, Smyth MD, Mori S. Functional MRI, Diffusion Tensor Fiber Tracking And Surgical Cortical Mapping Of Pediatric Tumors And Focal Cortical Lesions. Presented to the American Society of Neuroradiology, 2005.

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