Name of the Procedure:

Craniotomy with elevation of bone flap; for removal of epidural or subdural electrode array, without excision of cerebral tissue (separate procedure).

Summary

A craniotomy with elevation of the bone flap involves the surgical removal of a part of the skull, known as a bone flap, to access the brain and remove an electrode array placed on the surface of the brain or in the epidural space. The procedure does not involve the removal of brain tissue.

Purpose

This procedure is performed to remove an electrode array that was previously placed for monitoring brain activity, often to manage and treat epilepsy or other neurological conditions. The goal is to safely remove the electrodes without damaging the underlying brain tissue, thus preventing infection or other complications and allowing for accurate diagnostic evaluations.

Indications

• Electrode arrays placed for the diagnosis or management of epilepsy or other seizure disorders.
• Neurological monitoring for brain function assessments.
• Removal of electrodes after successful data collection or to alleviate complications such as infection or irritation.

Preparation

• Fasting for at least 6-8 hours before the procedure.
• Medication adjustments, including stopping blood thinners as advised.
• Preoperative diagnostic tests including MRI or CT scans and blood tests to assess readiness for surgery.
• Signing an informed consent form.

Procedure Description

1. The patient is positioned and given general anesthesia.
2. An incision is made in the scalp to expose the skull.
3. A section of the skull (bone flap) is carefully removed to access the brain.
4. The electrode array is located and delicately removed.
5. The bone flap is replaced and secured with plates or screws.
6. The scalp incision is closed with sutures or staples.

Duration

The procedure typically takes between 2 to 4 hours.

Setting

It is usually performed in a hospital operating room.

Personnel

• Neurosurgeon
• Surgical Nurses
• Anesthesiologist
• Operating Room Technicians

Risks and Complications

• Infection
• Bleeding or hematoma
• Swelling of the brain (cerebral edema)
• Seizures
• Adverse reactions to anesthesia
• Risk of injury to brain tissue, though minimal since no brain tissue is excised

Benefits

• Removal of electrode arrays that are no longer necessary.
• Prevention of infections or complications from retained electrodes.
• Completion of diagnostic evaluations for effective treatment planning.

Recovery

• Monitoring in the intensive care unit (ICU) for 24-48 hours post-procedure.
• Pain medications to manage discomfort.
• Stitches or staples are usually removed in 1-2 weeks.
• Recovery time varies; patients often resume normal activities within 4-6 weeks.
• Follow-up appointments to monitor healing and neurological status.

Alternatives

• Non-surgical management of hardware-related complications if feasible.
• Leaving the electrodes in place if removal poses a high risk.
• Alternative imaging or monitoring techniques if available.

Patient Experience

During the procedure, the patient will be under general anesthesia and will not feel anything. Post-procedure, there may be mild to moderate pain at the surgical site, managed with pain medications. There may be some swelling and bruising, and patients will need to rest and avoid strenuous activities during recovery.