Lesionectomy is a specialised brain surgery designed to remove abnormal tissue causing seizures or other neurological issues, especially in patients who do not respond well to medications. It targets specific brain lesions identified through detailed imaging and diagnostic evaluations.
The procedure involves opening a small part of the skull (craniotomy) to access and carefully remove the lesion, with the help of advanced tools like brain mapping and surgical navigation to avoid damage to healthy brain areas.
Lesionectomy can significantly reduce or stop seizures and may also improve cognitive and functional abilities. Recovery depends on the lesion’s location and complexity, and patients are often supported with short-term rehabilitation and ongoing medical follow-up.
- Frequent or uncontrolled seizures, especially if medications are ineffective
- Neurological symptoms such as weakness, vision changes, speech difficulties, or memory problems
- Changes in personality or cognition
- Brain imaging (MRI, CT) that shows a lesion with unclear or suspicious features
- Neuroimaging: MRI, PET, or CT scans to locate the lesion
- EEG monitoring: To map seizure activity and confirm the lesion as the source
- Neuropsychological testing: To assess memory, language, and cognitive functions
- Functional MRI or brain mapping: To identify areas responsible for vital functions like speech or movement
- Medication review: Some drugs may be paused or adjusted before surgery
- Fasting: Usually required 6–8 hours before the procedure
- Anaesthesia: The patient is placed under general anaesthesia.
- Craniotomy: A portion of the skull is carefully opened to access the brain.
- Navigation and Mapping: Advanced imaging and intraoperative brain mapping guide the surgeon to locate the lesion precisely.
- Lesion Removal: The abnormal tissue is removed, taking care to avoid surrounding healthy or functional areas.
- Closure: The bone flap is replaced, and the scalp is sutured.
- Infection
- Bleeding
- Brain swelling
- Neurological deficits (speech, memory, or motor issues, depending on location)
- Seizures after surgery
- Cerebrospinal fluid leakage
- Anesthesia-related complications
- Seizure reduction or elimination, especially in drug-resistant epilepsy
- Improved quality of life, cognitive function, and independence
- Minimal disruption to the surrounding brain tissue when precisely targeted
- Increased effectiveness of medications post-surgery, if still required
- It can sometimes eliminate the need for lifelong anti-seizure medication
- Patients are initially monitored in the ICU and then transferred to a regular neurology unit.
- Headaches, fatigue, or confusion are common during early recovery.
- Physical, occupational, or speech therapy may be needed depending on outcomes.
- Most patients resume light activities in 2 to 4 weeks and return to work or school within 6 to 8 weeks.
- Follow-up includes neuroimaging, EEGs, and ongoing neurology consultations.
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- Preoperative Evaluation: This includes a neurological exam, EEG, MRI, and sometimes intracranial monitoring to localise the lesion.
- Surgical Planning: Advanced imaging and brain mapping are used to plan a safe and precise lesion removal.
- Surgery (Lesionectomy): The identified brain lesion is surgically removed through a craniotomy.
- Intraoperative Monitoring: Brain function is continuously monitored to protect vital areas of the brain.
- Postoperative Care: Includes observation in the ICU, pain management, and neurological assessments.
- Rehabilitation: This may involve physical, occupational, or speech therapy, depending on the specific brain area affected.
- Follow-up and Monitoring: Conduct long-term follow-up, including imaging and seizure monitoring, to assess outcomes and evaluate the effectiveness of treatment.
- Drug-resistant epilepsy: Lesionectomy is performed when seizures persist despite optimal medication.
- Low-grade gliomas: The surgery removes slow-growing brain tumours that contribute to seizure activity.
- Cortical dysplasia: Abnormal brain tissue responsible for seizures is surgically eliminated.
- Cavernous malformations: These vascular lesions, which cause recurrent seizures, are safely excised.
- Gangliogliomas: Rare tumours made up of nerve and glial cells are removed to help manage epilepsy.
- Dysembryoplastic neuroepithelial tumours (DNETs): Benign brain growths that trigger seizures are taken out.
- Arteriovenous malformations (selected cases): Certain vascular abnormalities linked with seizures are treated surgically.
- Benign brain lesions causing seizures: Non-cancerous brain abnormalities that generate seizures are targeted and removed.
- Hamartomas: These non-cancerous tissue overgrowths are excised when they cause epilepsy.
- Epileptogenic brain tumours: Tumours acting as a source of seizures are surgically treated.
- Neurological evaluation to confirm seizure origin or lesion-related symptoms.
- Imaging tests, such as MRI, CT scans, and PET scans, are used to locate the lesion accurately.
- EEG or intracranial monitoring to identify abnormal electrical activity.
- Surgical planning using neuronavigation and functional mapping.
- Craniotomy to access the lesion in the brain.
- Precise removal of the abnormal tissue causing seizures or symptoms.
- Intraoperative monitoring is used to ensure the safety of the surrounding brain areas.
- Closure of the surgical site and transfer to recovery or ICU for observation.
- Postoperative imaging to confirm complete lesion removal.
- Ongoing follow-up for seizure control and neurological function evaluation.
- Craniotomy
- Electrocorticography (ECoG)
- Stereoelectroencephalography (SEEG)
- Neuronavigation
- Intraoperative MRI
- Cortical mapping
- Functional MRI (fMRI)
- Brain biopsy
- Intracranial EEG monitoring
- Awake craniotomy
- Seizure control in patients with drug-resistant epilepsy
- Improved quality of life due to reduced or complete seizure freedom
- Preservation of brain function by targeting only the lesion
- Minimally invasive options are available in selected cases
- Faster recovery time compared to extensive brain surgeries
- Reduced medication dependence, often leading to dose reduction or discontinuation
- Accurate diagnosis and treatment, when combined with advanced imaging and monitoring techniques
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