61760 Stereotactic implantation of depth electrodes into the cerebrum for long-term seizure monitoring

Name of the Procedure:

Stereotactic Implantation of Depth Electrodes into the Cerebrum for Long-Term Seizure Monitoring

Common Names: Depth Electrode Implantation, Stereoelectroencephalography (SEEG)

Technical Terms: Stereotactic Depth Electrode Insertion

Summary

Stereotactic implantation of depth electrodes is a surgical procedure in which small, thin wires (electrodes) are implanted into specific areas of the brain. These electrodes are used to monitor brain activity over an extended period to help identify the source of seizures in individuals with epilepsy.

Purpose

This procedure is primarily used to diagnose and pinpoint the origin of seizures in patients with epilepsy, particularly when seizure activity is difficult to locate using non-invasive methods. The goal is to gather detailed information on brain activity to guide treatment planning, which may include surgical intervention.

Indications

• Persistent seizures that do not respond to medication (intractable epilepsy).
• Difficulty locating the seizure focus through non-invasive methods like scalp EEG.
• Pre-surgical evaluation for epilepsy surgery.
• When precise mapping of seizure activity is necessary to avoid damaging critical brain areas.

Preparation

• The patient will need to fast for a specified period before the procedure (usually 6-8 hours).
• Medication adjustments may be necessary, particularly for anticonvulsants.
• Pre-procedure diagnostic tests, such as MRI or CT scans, are performed to map brain anatomy and plan electrode placement.
• Blood tests and a thorough medical evaluation to assess overall health.

Procedure Description

1. The patient is placed under general anesthesia.
2. Using stereotactic guidance, small incisions are made in the scalp, and tiny holes are drilled into the skull.
3. Depth electrodes are inserted through these openings and precisely guided into targeted brain regions.
4. The electrodes are connected to external recording equipment to monitor brain activity.
5. Throughout the monitoring period, which can last several days to weeks, the patient stays in a specialized hospital unit where their brain activity and seizures are continuously recorded.

Duration

The initial surgical procedure usually takes several hours. Monitoring brain activity can last from a few days to a couple of weeks.

Setting

The procedure is performed in a hospital with specialized neurosurgery and neurodiagnostic facilities.

Personnel

• Neurosurgeon
• Neurosurgical team, including nurses and technicians
• Anesthesiologist
• Epileptologist (a neurologist specializing in epilepsy)

Risks and Complications

• Infection at the electrode implantation site
• Bleeding or bruising in the brain
• Damage to brain tissue
• Neurological complications, such as weakness or changes in sensation
• Allergic reactions to anesthesia
• Swelling or discomfort at the insertion sites

Benefits

• Precise identification of the seizure focus to guide potential epilepsy surgery.
• Improved seizure management and quality of life.
• Detailed brain activity mapping that can inform treatment decisions.

Recovery

• Close monitoring in the hospital for the duration of the electrode implantation.
• Post-procedure imaging to ensure electrode placements and assess for complications.
• Gradual return to normal activities with specific instructions from the medical team.
• Follow-up appointments for removal of electrodes and to discuss findings and treatment options.

Alternatives

• Non-invasive EEG monitoring (less precise for deep seizure foci).
• MRI or PET scans for brain activity imaging.
• Medication adjustments and trials of different anticonvulsant drugs.

Pros of the Procedure:

• Highly detailed and accurate mapping of seizure activity.
• Can lead to targeted surgical interventions.

Cons of Alternatives:

• Less precise localization of seizures.
• Potentially prolonged period of inadequate seizure control.

Patient Experience

• The patient will not feel pain during the procedure as it is performed under general anesthesia.
• Some discomfort and swelling at the scalp incision sites post-procedure.
• Continuous monitoring in a specialized hospital unit can be challenging but is crucial for successful outcomes.
• Pain management and medications will be provided to ensure comfort during the recovery period.

Pain management strategies and support from the medical team will help alleviate discomfort and address any complications promptly.