The most common epilepsy surgery is temporal lobectomy, what the temporal lobe is removed are part of it is removed. Other surgeries involve taking out lesions, such as tumors, or abnormal blood vessel abnormalities such as AVMs or cavernous angiomas. Those are called lesionectomies, when you specifically go in and take an abnormal area of the brain out that's not necessarily the temporal lobe. When doing that, obviously you have to make sure that it's not anywhere near an area that would impact speech or motor function; so much of the same workup is done, as with an epilepsy surgery, looking at functional MRIs: more intensive EEG monitoring if the patient has epilepsy. The different between a lesionectomy surgery and a seizure surgery for epilepsy is that if the patient has a lesion that's causing epilepsy, they don't just go after the lesion. They try to get as much of it as possible based on where the seizures are coming from as well to try and take care of the seizures as well as well as just the lesion.
Other surgeries include corpus callosotomy, which involves disconnecting the two hemispheres of the brain. That is usually done for children who have extremely severe seizures that are very frequent, and they're not amenable to taking out part of the brain. They don't have a lesion that would cure them, so that the goal would be to disconnect the two hemispheres and make sure that the brain can't make really severe seizures and protect the brain that way.
The other brain surgeries include functional hemispherectomy when you disconnect not just the two hemispheres, but the whole hemisphere away from the other hemisphere, disconnect all the connections. That's usually done in very rare circumstances in children with specific infections.
Other less invasive surgeries are the vagal nerve stimulation which is like a pacemaker that you put in the chest. A wire is attached to a nerve in the neck, and then it's turned on and gives an electrical pulse every few seconds (or minutes, however it's set) so that that travels back to the brain and then affects the ability of the brain to cause seizures. It works over a longer period of time, it takes longer for it to build up and actually change seizures, and then will last longer if you turn it off. That one has a very good success rate but it usually doesn't make people seizure free, more reduction of seizures rather than seizure freedom.
