New surgery, new possibilities

For parents of children struggling with epilepsy, deciding the best path for treatment can be daunting. If medicines don’t work, surgery is often the next option, which can create additional stress for both patient and family. Fortunately, Texas Children’s Hospital – ranked No. 3 in the nation for pediatric neurology and neurosurgery by U.S. News & World Report – is pushing the boundaries of neurosurgery, becoming one of only a few centers in the world to offer an innovative, minimally invasive surgical approach that has the potential to benefit children with certain types of epilepsy.

“We are very excited about this new development,” said Texas Children’s Chief of Neurosurgery Dr. Howard Weiner. “This new surgical offering at Texas Children’s highlights another reason why we as a division of neurosurgery and as an institution are the destination for high-quality, world-class innovative and attentive care for children.”

When experts discover a child’s seizures originate from one particular side (hemisphere) of the brain, a hemispherotomy may be performed. Traditionally, this surgery involves making a large question mark-shaped incision on the top and side of the head. Certain surgical cuts are then made to disconnect the right and left hemispheres of the brain, both to mitigate seizures in the affected side and to keep seizures from spreading to the unaffected side.

The new, minimally invasive endoscopic procedure is performed through a much smaller opening in the head that translates to less blood loss, less postoperative pain, less discomfort and swelling, and a quicker recovery.

“When patients have multiple seizures every day for years, every day and every week of seizure freedom is a very big deal for these children and their families,” said Texas Children’s neurosurgeon Dr. Sandi Lam. “Patients who reach the three-, six- or 12-month and longer time points of being seizure free after undergoing this procedure are all considered important milestones and a significant, ongoing measure of success.”

Lam performed Texas Children’s first endoscopic hemispherotomy on an 11-year-old boy who had been experiencing five to six seizures per day, despite taking many different medications to control them. In the months following the procedure, the patient, whose life had been upended by frequent and unpredictable seizures, was seizure-free and making strides in recovery.