Epilepsy Surgery

At the UCSF Epilepsy Center, neurosurgeons perform a wide variety of surgical procedures for adults and children that can result in life-long control of seizures.

Who is a candidate for epilepsy surgery?

Many patients may be candidates for one of the surgical interventions we offer. The best way to know if you are a candidate is to come in for a clinic appointment to discuss your individual case. A pre-surgical evaluation can help determine the type of epilepsy you have and what options may be offered to you.
FAQ about Pre-surgical Evaluations for Epilepsy Surgery

What kind of surgeries and treatments does UCSF offer for epilepsy?

We tailor our approach to each patient and may be able to offer one of the following options:

Resection of the Epileptic Region
The most common type of surgery for epilepsy involves removing (resecting) the small area of brain tissue where a patient’s seizures are originating. Surgeons use information from a presurgical evaluation — including extensive preoperative EEG monitoring and state-of-the-art brain imaging modalities — to pinpoint the region of abnormal neuronal activity. This region can be close to or overlap areas of the brain used in language, movement, memory and emotion (the so-called eloquent areas of brain). In order to protect these processes, UCSF neurosurgeons use advanced brain mapping techniques to ensure that normal brain tissue is protected.

Some patients may undergo “awake” surgery during which sedation is lightened for part of the surgery in order to perform language and memory testing. Patients do not feel any discomfort and this type of procedure simply allows us to perform surgeries using the greatest amount of information and precision.

Stereoelectroencephalography (SEEG) is another tool that may be used to locate the source of seizures. This cutting-edge technology is less invasive than the standard subdural grid used to localize seizures and is only available at a handful of institutions in the United States.

Visualase Thermal Ablation for Epilepsy
UCSF is currently offering a minimally invasive laser surgery called Visualase thermal ablation to eliminate seizure foci. With this new surgery, an MR-compatible laser fiber is guided toward the source of a patient's seizures. Then the laser heats and destroys the small, well-defined area of abnormal tissue, leaving the surrounding tissue unharmed.
FAQ for Visualase Laser Thermal Ablation at UCSF

NeuroPace® Responsive Neurostimulation® for Epilepsy
For select patients, UCSF is offering an implanted brain stimulator to treat seizures. The Responsive Neurostimulation (RNS) system involves a programmable device that senses abnormal electrical activity in the brain and delivers electrical stimulation to terminate seizures before a patient experiences symptoms.
FAQ for NeuroPace Responsive Neurostimulation at UCSF

Vagus Nerve Stimulation
A vagus nerve stimulator is an implanted device that sends regular electrical pulses through the vagus nerve to the brain in order to potentially reduce the onset or frequency of seizures. It can be used to treat a wide variety of adult and pediatric seizure disorders that are not amenable to treatment by other surgical techniques.

Gamma Knife® Radiosurgery
Radiosurgery is most often used to treat seizures caused by hypothalamic hamartomas in adults and children (gelastic seizures). UCSF uses the most current model of the Gamma Knife units, the Perfexion®.

UCSF is currently evaluating results of a Phase III trial using Gamma Knife radiosurgery to treat temporal lobe epilepsy. This trial is closed for enrollment.