{"id":7333,"date":"2025-11-03T11:05:56","date_gmt":"2025-11-03T10:05:56","guid":{"rendered":"https:\/\/neurohirurgija.in.rs\/?page_id=7333"},"modified":"2026-06-04T10:45:39","modified_gmt":"2026-06-04T08:45:39","slug":"epilepsy-surgery-when-it-is-the-right-option","status":"publish","type":"page","link":"https:\/\/neurohirurgija.in.rs\/en\/epilepsy-surgery-when-it-is-the-right-option\/","title":{"rendered":"Epilepsy Surgery: When It Is the Right Option"},"content":{"rendered":"\n

Author:<\/strong> Dr. Zeljko Kojadinovic, MD, PhD \u2013<\/a> Neurosurgeon and Pain Management Specialist<\/strong><\/p>\n\n\n\n

Last medically reviewed: January 17, 2026<\/p>\n\n\n\n

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\n Who is this page for?\n <\/div>\n

\n This page is intended for patients and families who want clear, evidence-based information about epilepsy surgery<\/strong>\u2014when it is considered for drug-resistant epilepsy, how candidates are evaluated, and what procedures (e.g., temporal lobectomy, selective mesial resection, laser ablation, neurostimulation), outcomes, and risks to expect.\n It is not a substitute for medical advice. For an expert review of your case, see our page on\n \n neurosurgery second opinion\n <\/a>.\n <\/p>\n<\/div>\n\n\n\n

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\n Epilepsy Surgery \u2014 Quick Summary (Read This First)\n <\/h3>\n\n
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  • \n Most people with epilepsy never need surgery.<\/strong>\n About 70\u201375% achieve good seizure control with medication alone.\n <\/li>\n\n
  • \n Surgery is considered for drug-resistant epilepsy.<\/strong>\n If seizures persist despite adequate trials of two appropriate medications, further drug changes rarely lead to seizure freedom.\n <\/li>\n\n
  • \n Epileptic seizures arise from cortical networks.<\/strong>\n Surgery targets a specific area of the cerebral cortex where seizures begin, even when deeper structures participate in seizure spread.\n <\/li>\n\n
  • \n Careful presurgical evaluation is essential.<\/strong>\n MRI, EEG, video-EEG monitoring, and sometimes invasive recordings are used to localize the epileptogenic zone and assess surgical safety.\n <\/li>\n\n
  • \n Surgery is not \u201cexperimental\u201d or a last resort.<\/strong>\n In properly selected patients, epilepsy surgery is an evidence-based treatment with long-term seizure freedom in 50\u201380%, depending on the epilepsy type.\n <\/li>\n\n
  • \n Temporal lobe epilepsy has the best outcomes.<\/strong>\n Procedures such as anterior temporal lobectomy or selective mesial resection achieve seizure freedom in the majority of suitable patients.\n <\/li>\n\n
  • \n Not all epilepsy surgeries involve large operations.<\/strong>\n Minimally invasive options (laser ablation, SEEG-guided thermocoagulation, neurostimulation) may be appropriate in selected cases.\n <\/li>\n\n
  • \n Secondary (structural) epilepsies often have a surgically treatable cause.<\/strong>\n In many patients, seizures are triggered by a well-defined lesion that irritates the cerebral cortex \u2014 such as a cortical scar after trauma or stroke, cavernous malformation, arteriovenous malformation (AVM), low-grade tumor, focal cortical dysplasia, or post-infectious gliosis. When this epileptogenic lesion can be identified and safely removed, surgery may eliminate seizures rather than only suppressing them with medication.\n<\/li>\n\n\n
  • \n The goal is more than seizure reduction.<\/strong>\n Successful surgery aims to improve quality of life, reduce medication burden, and allow long-term neurological stability.\n <\/li>\n\n
  • \n Use the Contents box<\/strong>\n to jump directly to sections on candidacy, diagnostic work-up, specific procedures, risks, outcomes, or recovery.\n <\/li>\n <\/ul>\n<\/div>\n\n

    \n Most readers only need this summary and the sections on When Surgery Is Considered<\/strong> and Main Surgical Procedures<\/strong>.\n The remaining sections are available for deeper understanding and specific clinical questions.\n<\/p>\n\n\n\n\n