Name of the Procedure:

Craniotomy with elevation of bone flap for excision of epileptogenic focus without electrocorticography (ECoG).

Summary

A craniotomy with elevation of bone flap to excise an epileptogenic focus is a surgical procedure where a portion of the skull bone is temporarily removed to access the brain and remove the area causing seizures. This procedure does not involve the use of electrocorticography (ECoG) to map brain activity during surgery.

Purpose

This procedure addresses epilepsy that cannot be controlled with medication. The goal is to reduce or eliminate seizures by removing the brain tissue generating abnormal electrical activity.

Indications

• Intractable epilepsy (seizures not controlled by medications)
• Identified location of epileptogenic focus through pre-surgical evaluations
• Candidate for surgery based on overall health and diagnostic tests

Preparation

• Fasting for 8-12 hours before surgery
• Medication adjustments as directed by the surgeon
• Pre-surgical assessments including MRI, CT scans, and possibly functional mapping

Procedure Description

1. General anesthesia is administered to the patient.
2. The scalp is cleaned and a portion is incised to expose the skull.
3. A bone flap is temporarily removed to access the brain.
4. The specific epileptogenic focus is identified using preoperative mapping, and the targeted brain tissue is carefully excised.
5. The bone flap is replaced and secured, and the scalp is sutured back in place.

Duration

The procedure typically takes between 3 to 6 hours, depending on the complexity.

Setting

This surgery is performed in a hospital operating room equipped for neurosurgical procedures.

Personnel

• Neurosurgeon
• Anesthesiologist
• Surgical nurses
• Surgical technologists

Risks and Complications

• Infection
• Bleeding
• Neurological deficits (e.g., weakness, sensory loss, speech difficulties)
• Seizure exacerbation
• Cerebrospinal fluid leak
• Complications related to anesthesia

Benefits

• Potential reduction or elimination of seizures
• Improved quality of life
• Possible reduction in the need for anti-epileptic medications

Recovery

• Hospital stay of 3 to 7 days
• Pain management with prescribed medications
• Gradual resumption of normal activities over weeks to months
• Follow-up appointments to monitor recovery and assess seizure control
• Physical or occupational therapy if needed for neurological deficits

Alternatives

• Continued medical management with anti-epileptic drugs
• Other surgical options like vagus nerve stimulation (VNS)
• Laser ablation or radiofrequency thermocoagulation for minimally invasive surgery
• Each alternative has varying success rates, benefits, and risks

Patient Experience

• Patients will be under general anesthesia and won't experience the procedure itself.
• Post-operatively, some pain and discomfort at the surgical site can be expected, managed with medication.
• Fatigue and mild headaches are common during the initial recovery period.
• Gradual improvement in seizure frequency and quality of life if successful.