Epilepsy Surgery in Ahmedabad — Complete Pre-Surgical Evaluation

For patients with drug-resistant epilepsy, surgery offers the best chance of achieving seizure freedom. At Gujarat Epilepsy & Neuro Clinic, we provide complete epilepsy surgery evaluation services to determine if surgical intervention could help you live a seizure-free life.

Dr. Rutul Shah and Dr. Abhishek Gohel, both NIMHANS-trained epileptologists with specialized training from Amrita Institute, Kochi and Amrita Kochi respectively, bring extensive experience in pre-surgical evaluation and work closely with leading neurosurgical centers to coordinate your complete care.

Who is a Candidate for Epilepsy Surgery?

Not all patients with epilepsy are candidates for surgery, but those who meet specific criteria may benefit tremendously. At our epilepsy surgery evaluation center in Ahmedabad, we assess patients who:

• Have drug-resistant epilepsy: Seizures continue despite trying at least two appropriate anti-seizure medications
• Have focal seizures: Seizures that originate from a specific, identifiable area of the brain
• Have an identifiable seizure focus: The location where seizures start can be clearly mapped
• Have adequate seizure frequency: Enough seizures to significantly impact quality of life
• Are willing to undergo evaluation: Complete testing and potential surgical risks are acceptable
• Have failed medical optimization: Multiple medication trials have been unsuccessful

Specific Conditions That May Benefit from Surgery

• Temporal lobe epilepsy with hippocampal sclerosis
• Focal cortical dysplasia (FCD)
• Cavernous malformations causing seizures
• Low-grade tumors associated with epilepsy
• Post-stroke or traumatic epilepsy with clear lesions
• Tuberous sclerosis complex with dominant tubers

What Happens During Epilepsy Surgery?

Understanding the surgical process can help ease anxiety for patients and families. Here is what typically happens during epilepsy surgery:

Before the Operation

The neurosurgical team reviews all pre-surgical evaluation data — video-EEG findings, MRI scans, neuropsychological test results, and the surgical plan. The patient receives a detailed counselling session where the surgical approach, expected outcomes, and specific risks are explained. Written informed consent is obtained.

In the Operating Room

The procedure is performed under general anaesthesia in most cases. For surgeries near critical brain areas that control speech, language, or movement, an awake craniotomy may be used — the patient is kept conscious during specific portions so the team can test brain function in real time.

Key steps during the surgery include:

• Craniotomy: A section of the skull bone is carefully removed to access the brain
• Neuronavigation: Computer-guided imaging helps the surgeon precisely locate the epileptogenic zone identified during pre-surgical evaluation
• Electrocorticography (ECoG): Electrodes placed directly on the brain surface record electrical activity and confirm the seizure focus in real time
• Cortical stimulation mapping: Small electrical currents identify areas controlling speech, motor function, and sensation — these areas are carefully preserved
• Resection or disconnection: The epileptogenic tissue is removed or disconnected based on the surgical plan
• Intraoperative neuromonitoring: Continuous monitoring of somatosensory evoked potentials (SSEP) and motor evoked potentials (MEP) ensures critical neural pathways remain intact
• Closure: The bone flap is replaced and secured, and the scalp is closed

The entire procedure typically takes 3 to 6 hours, depending on the type of surgery and complexity of the case. For procedures involving stereoelectroencephalography (SEEG) electrode implantation, a two-stage approach may be used — first implanting electrodes for monitoring, then performing the definitive surgery based on recorded data.

Risks and Complications of Epilepsy Surgery

Like any brain surgery, epilepsy surgery carries certain risks. However, for patients with drug-resistant epilepsy, the risks of continued uncontrolled seizures — including injury, cognitive decline, and sudden unexpected death in epilepsy (SUDEP) — often outweigh the surgical risks.

General Surgical Risks

• Infection at the surgical site (uncommon with modern sterile techniques)
• Bleeding (haematoma formation)
• Adverse reactions to anaesthesia
• Blood clots (deep vein thrombosis)

Neurological Risks

• Memory changes: Particularly with temporal lobe surgery. Some patients experience mild verbal or visual memory changes. Detailed neuropsychological testing before surgery helps predict and minimise this risk.
• Speech and language difficulties: May occur if surgery is near language areas. Cortical mapping during surgery helps protect these zones. Most speech difficulties, when they occur, are temporary.
• Visual field deficits: A partial visual field cut (superior quadrantanopia) can occur after temporal lobe surgery. This is usually asymptomatic and rarely affects daily functioning.
• Weakness or numbness: Temporary weakness in an arm or leg may occur depending on the surgical location. This typically improves over weeks to months.
• Mood changes: Some patients experience transient anxiety or mood fluctuations in the early post-operative period. Psychological support is available throughout recovery.

The specific risks depend on the type of surgery and the brain region involved. Your epileptologist and neurosurgeon will discuss the individual risk profile specific to your case during the pre-surgical counselling session.

This information is for educational purposes. Individual risk profiles vary — consult your treating neurologist for a personalised assessment.