Name of the Procedure:

Subdural implantation of strip electrodes through 1 or more burr or trephine hole(s) for long-term seizure monitoring

Summary

This procedure involves inserting thin, flexible strips of electrodes beneath the dura mater (the outermost membrane surrounding the brain) through small holes drilled into the skull. The electrodes are used to continuously monitor brain activity over an extended period to diagnose and manage seizure disorders.

Purpose

• Medical Condition: Epilepsy or other seizure disorders.
• Goals: To accurately locate seizure foci in the brain, thereby aiding in the diagnosis and guiding potential surgical interventions for better seizure control.

Indications

• Persistent seizures despite medication.
• Need for precise localization of seizure activity.
• Candidates for epilepsy surgery.
• Non-invasive testing methods have provided inconclusive results.

Preparation

• Pre-procedure Instructions: Patients may need to fast (no food or drink) for a specified period before the procedure.
• Medication Adjustments: Some medications may need to be stopped or adjusted.
• Diagnostic Tests: Preoperative imaging (MRI, CT scans) and baseline EEG.

Procedure Description

1. Anesthesia: General anesthesia is administered.
2. Drilling Holes: Small burr or trephine holes are made in the skull.
3. Electrode Placement: Strip electrodes are carefully inserted through the holes and positioned subdurally over specific brain regions.
4. Monitoring Setup: Electrodes are connected to an external monitoring device for continuous EEG recording.
5. Closure: The incision sites are closed and bandaged.

Duration

The procedure typically takes several hours, from preparation to completion.

Setting

Performed in a hospital operating room equipped for neurological procedures.

Personnel

• Neurosurgeon
• Anesthesiologist
• Surgical nurses
• EEG technologists

Risks and Complications

• Common Risks: Infection, bleeding, swelling.
• Rare Risks: Seizure during electrode placement, neurological deficits.
• Management: Infections are managed with antibiotics, and any complications are addressed based on their nature and severity.

Benefits

• Expected Benefits: Precise localization of seizure activity.
• Timeline: Diagnostic benefits realized as soon as sufficient seizure data is recorded, leading to potential surgical treatment.

Recovery

• Post-procedure Care: Monitoring in a hospital setting, pain management, wound care.
• Recovery Time: Varies depending on individual patient responses and extent of monitoring required.
• Restrictions: Limited activity and follow-up appointments to assess healing and outcomes.

Alternatives

• Non-Invasive EEG Monitoring: Less invasive but may be less accurate.
• Magnetoencephalography (MEG): Non-invasive mapping, though limited in availability.
• MRI-guided Focused Ultrasound: Emerging treatment with varying efficacy.

Patient Experience

• During the Procedure: The patient is under general anesthesia and feels no pain.
• After the Procedure: Patients may experience some discomfort or pain at the incision sites, managed with pain medication. Postoperative hospital stay for monitoring and recovery is required.