Risks of Epilepsy Surgery

Epilepsy is a neurological disorder characterized by recurrent seizures that occur as a result of abnormal changes in the electrical activity of the brain. In a significant proportion of epilepsy patients, seizures can be controlled with medication. However, in some patients whose seizures continue despite appropriately used epilepsy medications, surgical treatment options may be considered.

The main aim of epilepsy surgery is to identify the area of the brain where seizures begin as accurately as possible and to reduce or control seizures while preserving important neurological functions. However, as with every surgical procedure, epilepsy surgery also carries certain risks.

Prof. Dr. Ömür Günaldı states that when planning epilepsy surgery, it is important to evaluate in detail the patient’s seizure type, the area where the seizures begin, MRI and EEG findings, and important brain functions such as speech, movement, vision, and memory.

Is Epilepsy Surgery Risky?

Because epilepsy surgery is performed within the field of neurosurgery, it is a procedure that requires serious and detailed planning. However, the level of risk is not the same for every patient.

• The type of epilepsy surgery to be performed
• The location of the seizure focus in the brain
• The proximity of the surgical area to speech and movement centers
• The possibility of affecting brain regions related to memory
• The patient’s age
• The patient’s general health condition
• Previous brain surgeries
• The cause of epilepsy
• The extent of the surgical procedure

For this reason, an individual risk rate cannot be determined simply by asking, “Is epilepsy surgery risky?” A patient-specific evaluation is required.

What Are the General Risks of Epilepsy Surgery?

Epilepsy surgery may involve both general surgical risks and neurological risks specific to the brain region being treated.

Risk of Bleeding

Brain tissue and the blood vessels surrounding it are highly sensitive. Bleeding during or after surgery is one of the possible complications.

Depending on the size and location of the bleeding, additional monitoring or treatment may be required. For this reason, controlling bleeding during surgery is of great importance.

Risk of Infection

As with any surgical procedure, there is a possibility of developing an infection after epilepsy surgery.

Infection may occur:

• At the surgical wound,
• Around the skull,
• In deeper tissues.

Monitoring the surgical site after the operation and evaluating signs of infection at an early stage are important.

Risks Related to Anesthesia

A significant proportion of epilepsy surgeries are performed under general anesthesia. Although complications related to general anesthesia are rare, they may occur.

The patient’s existing medical conditions and general health status are taken into consideration when assessing anesthesia-related risks.

Neurological Risks After Epilepsy Surgery

One of the most important considerations in epilepsy surgery is preserving healthy brain tissue and critical functions. This is because the seizure focus may be close to brain regions responsible for important functions in some patients.

Prof. Dr. Ömür Günaldı emphasizes that detailed preoperative examinations are important for identifying the surgical area and preserving neurological functions as much as possible.

Memory Problems

Memory functions are carefully evaluated, especially in epilepsy surgeries involving the temporal lobe. Certain parts of the temporal lobe are closely associated with learning and memory.

After surgery, some patients may experience:

• Difficulty learning new information,
• Difficulty recalling words,
• Changes in short-term memory.

The risk and severity of memory changes may vary depending on the area where the surgery is performed and the patient’s cognitive condition before surgery.

Speech and Language Problems

If the seizure focus is close to areas of the brain related to language functions, a special assessment of speech and language abilities may be required.

Some patients may experience temporary or longer-lasting problems after surgery, such as:

• Difficulty finding words,
• Difficulty forming speech,
• Difficulty understanding what is being said.

For this reason, evaluations performed by Prof. Dr. Ömür Günaldı take into account the relationship between the surgical area and the functional regions of the brain.

Visual Field Problems

One of the neurological complications that may occur after epilepsy surgery is a change in the visual field. In particular, after some surgical procedures involving the temporal region, loss may occur in certain parts of the visual field.

This change may be mild, while in some patients it may be severe enough to affect daily life.

Loss of Strength in the Arm or Leg

If the surgical area is close to regions responsible for movement functions, the risk of reduced muscle strength may be evaluated.

In rare cases after surgery, the following may occur:

• Weakness in the arm,
• Weakness in the leg,
• Difficulty with fine motor movements,
• Coordination problems.

These neurological effects may be temporary in some patients, while there is also a possibility that they may become permanent depending on the location and extent of the damage.

Can Seizures Continue After Epilepsy Surgery?

Epilepsy surgery does not necessarily mean that seizures will completely stop. While some patients become seizure-free after surgery, in others the frequency or severity of seizures may decrease. In some cases, the expected level of seizure control may not be achieved.

For this reason, Prof. Dr. Ömür Günaldı states that the outcomes a patient may expect from surgery and the possible risks should be evaluated individually before the operation.

Can Psychological Changes Occur After Epilepsy Surgery?

After epilepsy surgery, not only physical and neurological changes but also changes related to mood may occur.

Some patients may experience:

• Anxiety,
• Changes in mood,
• Depressive symptoms,
• Difficulty adapting to life after surgery.

For this reason, the patient’s psychological condition may also need to be evaluated before and after surgery.

How Can the Risks of Epilepsy Surgery Be Reduced?

One of the most important stages of epilepsy surgery is the comprehensive evaluation performed before the operation. The aim is not only to identify the seizure focus but also to determine whether surgery can be performed safely.

Depending on the patient, the following may be used before surgery:

• Video EEG,
• Brain MRI,
• Neuropsychological tests,
• Functional imaging methods,
• Neurological evaluations,
• Advanced epilepsy surgery investigations when necessary.

These tests aim to determine as accurately as possible the region where seizures begin and the important brain functions surrounding that area.

Why Is Preoperative Evaluation Important Before Epilepsy Surgery?

Because the risks of epilepsy surgery vary from person to person, the surgical decision is not made solely based on the diagnosis of epilepsy. The response of seizures to medications, whether the seizure focus can be identified, and whether this area can be treated surgically in a safe manner are evaluated together.

Prof. Dr. Ömür Günaldı states that epilepsy surgery should be planned individually and that the expected benefit in terms of seizure control and the possible surgical risks should be considered together.

In epilepsy surgery, risks such as bleeding, infection, memory and speech changes, visual field problems, loss of strength, and continuation of seizures may occur. However, not all of these risks occur in every patient, and the level of risk varies significantly depending on the type of surgery, the location of the seizure focus, and the patient’s individual characteristics. Therefore, surgical suitability and personal risks should be determined after a detailed epilepsy surgery evaluation.