Illustration of a child's brain with seizure foci being treated with precision surgery.

Epilepsy Surgery Breakthrough: Can Staged Procedures Offer Children a Seizure-Free Future?

Rhea Morgan in Health & Wellness December 2025 • 4 min read.

"New research explores how staged epilepsy surgery, enhanced with post-resection monitoring, is transforming outcomes for children with neocortical lesions."

For children battling neocortical epilepsy, where seizures originate from lesions in the brain's outer layer, surgery offers a beacon of hope. However, the complete removal of these seizure-generating zones is a delicate challenge, often determining the long-term success of the procedure. Unlike temporal lobe epilepsy surgery, which has a higher success rate, neocortical epilepsy surgery presents unique obstacles that demand innovative solutions.

A recent study published in "Epilepsy Research" sheds light on a promising approach: staged epilepsy surgery combined with post-resection invasive monitoring (PRM). This method involves an initial surgery to remove the primary lesion, followed by a period of intensive monitoring to detect any remaining seizure activity. If necessary, a second surgery is performed to address these residual epileptogenic zones.

The study, conducted at New York University Langone Health, retrospectively reviewed the outcomes of pediatric patients who underwent this staged surgical approach. The findings suggest that PRM can significantly improve seizure control in children with neocortical epilepsy, offering renewed hope for a seizure-free future.

Staged Epilepsy Surgery: A Step-by-Step Approach to Seizure Control

Illustration of a child's brain with seizure foci being treated with precision surgery.

The staged surgical approach offers several key advantages in treating complex neocortical epilepsy. Unlike a single-step resection, which relies solely on pre-operative imaging and monitoring data, the staged approach allows surgeons to:

Precisely target the seizure onset zone: Invasive monitoring helps pinpoint the exact location where seizures originate, ensuring that the resection focuses on the most critical areas.

Identify and resect residual epileptogenic activity: PRM can detect seizure activity at the margins of the resection cavity that may have been missed during the initial surgery.
Unmask additional seizure foci: In some cases, PRM reveals previously undetected seizure foci, allowing surgeons to address these areas in a subsequent resection.
Preserve eloquent cortex: By carefully mapping brain function during invasive monitoring, surgeons can minimize the risk of damaging critical areas responsible for motor, sensory, or language function.

The study's findings highlight the importance of complete resection in achieving long-term seizure control. In 86% of patients who underwent PRM, the monitoring revealed additional epileptogenic activity that warranted further intervention. This data directly influenced the decision to perform a second resection in 55 patients, ultimately leading to improved outcomes.

Looking Ahead: Optimizing Surgical Strategies for Epilepsy

While the study's results are encouraging, the authors acknowledge the limitations of a retrospective, uncontrolled design. Further research with longer follow-up periods is needed to identify more predictors for long-term seizure freedom. However, the findings suggest that staged epilepsy surgery with PRM may offer a valuable approach for children with complex neocortical epilepsy, potentially increasing the likelihood of a seizure-free future.

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Everything You Need To Know

What is neocortical epilepsy surgery, and why is it done?

Neocortical epilepsy surgery is a procedure performed on children whose seizures originate from lesions in the neocortex, which is the outer layer of the brain. It's significant because, unlike temporal lobe epilepsy surgery which has a higher success rate, neocortical epilepsy surgery presents unique challenges. This surgery aims to remove the seizure-generating zones to provide long-term seizure control. However, complete removal is a delicate challenge, making innovative solutions like staged surgery necessary. Without effective treatment, children with neocortical epilepsy may continue to experience debilitating seizures, impacting their development and quality of life.

What is staged epilepsy surgery, and why is it considered a better approach?

Staged epilepsy surgery is a surgical approach where, unlike a single surgery, the procedure is divided into steps. Initially, the primary lesion is removed. After this, post-resection monitoring (PRM) is conducted to detect any remaining seizure activity. If needed, a second surgery is performed to address these residual epileptogenic zones. This staged approach is important because it allows for more precise targeting and removal of seizure-generating areas, potentially leading to improved seizure control and better outcomes for children with neocortical epilepsy. This is especially important when dealing with lesions near the eloquent cortex.

What does post-resection monitoring (PRM) involve, and why is it a crucial step?

Post-resection monitoring (PRM) is an intensive monitoring period that occurs after the initial surgery in staged epilepsy surgery. During PRM, doctors look for any remaining seizure activity that may have been missed during the first surgery. PRM is significant because it helps identify and resect residual epileptogenic activity and can unmask additional seizure foci. This monitoring ensures a more complete resection of seizure-generating zones, which is vital for long-term seizure control. Without PRM, undetected seizure activity could lead to continued seizures despite the initial surgery.

What does 'complete resection' mean in the context of epilepsy surgery, and why is it important?

Complete resection in epilepsy surgery refers to the total removal of all seizure-generating zones within the brain. This is important because it significantly increases the likelihood of long-term seizure control. If any epileptogenic tissue remains, it can continue to cause seizures, negating the benefits of the surgery. The study highlights that in 86% of patients who underwent post-resection monitoring (PRM), additional epileptogenic activity was found, influencing the decision to perform a second resection in 55 patients. This demonstrates that complete resection, guided by PRM, is crucial for achieving a seizure-free future.

What is 'eloquent cortex,' and why is it important to preserve it during epilepsy surgery?

Eloquent cortex refers to areas of the brain responsible for critical functions like motor skills, sensory perception, and language. Preserving the eloquent cortex during epilepsy surgery is important to minimize the risk of causing neurological deficits. Surgeons carefully map brain function during invasive monitoring to avoid damaging these vital areas. The staged surgical approach, combined with post-resection monitoring (PRM), helps surgeons preserve the eloquent cortex by precisely targeting seizure onset zones and identifying residual epileptogenic activity, ensuring that the resection focuses on the most critical areas while sparing essential brain functions. Without careful mapping and a staged approach, there's a higher risk of damaging the eloquent cortex, leading to potential long-term disabilities.