The Pediatric Epilepsy Surgery Program at UPMC Children's Hospital of Pittsburgh, led by pediatric epilepsy surgeon Taylor Abel, MD and pediatric epileptologists Will Welch, MD and Ruba Al-Ramadhani, MD, provides the region’s most comprehensive and leading edge neurosurgical care for children with epilepsy. Our epilepsy program is one of the busiest in the region and evaluates over 1200 children with newly diagnosed epilepsy each year performing over 400 prolonged EEG evaluations for epilepsy annually.
Leading Edge Diagnosis
At UPMC Children's Hospital of Pittsburgh, we have an eight-bed epilepsy monitoring unit that specializes in monitoring children with complex epilepsy. The full range of epilepsy diagnostics are provided in addition to long-term EEG monitoring, including 3T MRI (with 7T MRI available for research), functional MR imaging, magnetoelectroencephalgraphy (MEG), FDG-PET, and Ictal SPECT. These imaging modalities enable our team to identify even the most difficult to localize epileptic foci noninvasively. However, when these modalities cannot precisely identify the epileptic focus, we also offer minimally invasive frameless robot-assisted stereoelectroencephalography (SEEG, see below)
Multidisciplinary Epilepsy Surgery Clinic
Epilepsy Surgery Clinic is a comprehensive clinic where are patients can see a pediatric neurologist, pediatric neurosurgeon, and other specialists on single day without requiring two or more visits to the clinic. In this setting, the pros and cons of various treatment options can be discussed with patients and their families with all relevant pediatric subspecialties available.
Our epilepsy program treats all epilepsy conditions and etiologies, including:
- Cavernoma-related Epilepsy (CRE)
- Focal Cortical Dysplasia
- Focal Epilepsy (Temporal Lobe, Frontal Lobe, etc).
- Hypothalamic Hamartoma
- Idiopathic Generalized Epilepsy
- Infantile Spasms / Epileptic Spasms
- Lennox-Gastaut Syndrome
- MR-negative Epilepsy (epilepsy associated with no relevant MRI findings)
- Periventricular and subcortical nodular heterotopias
- Rasmussen Encephalitis
- Post-traumatic Epilepsy
- Sturge-Weber Syndrome
- Tuberous Sclerosis
- Tumoral Epilepsy (epilepsy caused by a brain tumor)
- Vascular Epilepsy (e.g. epilepsy occurring due to brain hemorrhage or hypoxic-ischemic events)
Epilepsy Surgery Options
Seizure Focus Localization
When noninvasive means cannot identify the seizure focus, it is sometimes necessary to record directly from the brain to localize the seizure focus. For this purpose, we can provide robot-assisted stereoelectroencephalography (SEEG) and also subdural electrode implantations.
Robot-Assisted Frameless SEEG
SEEG is a minimally invasive technique that that provides direct recordings from the brain without performing a craniotomy. Often, this technique can be performed without a haircut or a minimal haircut. We are one of few pediatric centers with a dedicated ROSA robot enables electrodes to be placed with stereotactic accuracy without using a stereotactic frame. Our center is one of the only children’s hospitals in the country with both a ROSA robot and an intraoperative CT scanner (O-Arm) that enables precise and accurate implantation of SEEG electrodes.
Subdural Electrode Implantation (SDE)
Most of our patients who require brain recordings prior to epilepsy surgery are candidates for SEEG, but we also offer SDE implantation for children who are too young for SEEG (younger than two-years-old) or who require certain types of functional mapping.
MR-guided Laser Interstitial Thermal Therapy (LITT)
For many patients, we can provide MR-guided laser ablation of seizure foci. This is a technique were seizure foci can be ablated without craniotomy using a steretactically-implanted (with the ROSA robot) laser device. We perform this procedure in one of the region’s few pediatric intraoperative MRI suites.
We also offer traditional seizure focus resection surgery, including hemispherotomy, cortico-amygdalohippocampectomy (sometimes called ‘temporal lobectomy’), and other tailored cortical resections. The goal of this type of surgery is always to minimize seizures and to maximize functional outcome and developmental trajectory. When indicated, we also offer awake craniotomy for select patients who are comfortable with this option. Multiple subpial transections also performed.
Some patients may benefit from partial or complete separation of the corpus callosum when seizures are very debilitating or are associated with ‘drop attacks.’
Neuromodulation (VNS, DBS, and RNS)
We offer the full range of neuromodulation options for epilepsy and different options are offered based on the type of epilepsy being treated. These options are often reserved for when resective neurosurgery is not an option for various reasons. We are one of the most experienced pediatric centers with vagal nerve stimulation (VNS) and now offer both deep brain stimulation (DBS) and responsive neural stimulation (RNS).
For more information on pediatric epilepsy treatment, please visit the Epilepsy Center webpage on the UPMC Children's Hospital of Pittsburgh website, or call 412-692-6928.