Name of the Procedure:

Craniotomy with Elevation of Bone Flap; Subdural Implantation of an Electrode Array for Long-Term Seizure Monitoring

Summary

In this procedure, a section of the skull is temporarily removed to allow for the placement of electrodes on the brain's surface. These electrodes monitor brain activity to help identify the source of seizures.

Purpose

This procedure addresses epilepsy and other seizure disorders. The goal is to accurately locate the area of the brain where seizures originate to guide further treatment, which may include surgery to remove the problematic brain tissue.

Indications

• Patients with epilepsy that is not controlled by medication
• Frequent, severe seizures
• Seizures that disrupt daily life

Preparation

• Fasting for 8-12 hours before the procedure
• Pre-surgical assessments, including blood tests, imaging studies (MRI or CT scans), and a neurological exam
• Possible adjustments to seizure medications

Procedure Description

1. Anesthesia is administered to ensure the patient is asleep and pain-free.
2. A portion of the scalp is shaved and cleaned.
3. An incision is made to expose the skull.
4. A small piece of the skull, known as a bone flap, is removed.
5. The surgeon places a grid of small electrodes on the surface of the brain's subdural space.
6. The bone flap is replaced and secured.
7. The scalp is stitched closed, and the patient is moved to a monitoring unit.
8. The electrodes remain in place for several days to weeks to capture brain activity.

Duration

Approximately 3-6 hours.

Setting

Hospital operating room, followed by transfer to a specialized epilepsy monitoring unit.

Personnel

• Neurosurgeon
• Anesthesiologist
• Operating room nurses
• Neurophysiologist or neurologist specializing in epilepsy

Risks and Complications

• Infection
• Bleeding
• Swelling or increased pressure in the brain
• Neurological deficits or changes
• Seizures triggered by the electrodes themselves
• Anesthesia-related risks

Benefits

• Accurate identification of seizure origin
• Improved likelihood of effective surgical treatment
• Potential for better seizure control and quality of life

Recovery

• Close monitoring in a specialized unit for several days to weeks
• Pain management with medications
• Instructions to avoid strenuous activities
• Follow-up appointments for suture removal and additional treatment planning
• Gradual return to normal activities over a few weeks

Alternatives

• Continued medication management (with limited success in refractory epilepsy)
• Less invasive monitoring techniques (e.g., scalp EEG, MRI)
• Vagus nerve stimulation (VNS)
• Responsive neurostimulation device placement

Patient Experience

• Some discomfort and mild pain managed with medications
• Close and continuous monitoring by healthcare professionals
• Temporary restrictions on physical activities to allow healing
• Adjustment to the presence of external recording equipment