Name of the Procedure:

Craniotomy with elevation of bone flap; for excision of cerebral epileptogenic focus, with electrocorticography during surgery (includes removal of electrode array).
Common name: Epilepsy Surgery with Craniotomy and Electrocorticography

Summary

This procedure involves surgically opening the skull (craniotomy) to remove a section responsible for triggering seizures (epileptogenic focus) in the brain. Electrocorticography (ECoG) is performed during the surgery to monitor brain activity and guide the excision. The process includes removing any implanted electrode arrays used for mapping.

Purpose

The primary purpose of this surgery is to reduce or eliminate seizures in patients with epilepsy that cannot be managed with medication. The goal is to improve the patient’s quality of life by decreasing seizure frequency and severity.

Indications

• Drug-resistant epilepsy
• Frequent seizures that severely impact daily life
• Seizures localized to a specific brain area
• Good health and sufficient brain mapping data

Preparation

• Pre-procedure fasting (usually 8-12 hours)
• Medication adjustments as instructed by your physician
• Preoperative imaging studies such as MRI or CT scans for brain mapping
• Possible scalp EEG or other monitoring techniques

Procedure Description

1. The patient is placed under general anesthesia.
2. A portion of the skull is carefully removed to expose the brain (craniotomy).
3. Electrocorticography (ECoG) electrodes are placed on the brain surface to monitor electrical activity and identify the epileptogenic zone.
4. The identified brain tissue causing seizures is excised.
5. Removal of the electrode array used for localization.
6. The bone flap is replaced and secured.
7. The scalp incision is closed with sutures or staples.

Duration

The procedure typically takes between 4 to 6 hours, depending on complexity.

Setting

The procedure is performed in a hospital, specifically in an operating room equipped for neurosurgery.

Personnel

• Neurosurgeon
• Surgical nurses
• Anesthesiologist
• Neurophysiologist (for ECoG monitoring)
• Operating room technicians

Risks and Complications

• Infection and bleeding
• Brain swelling
• Neurological deficits (e.g., weakness, speech difficulties)
• Memory or cognitive changes
• Anesthetic complications
• Seizure persistence or recurrence

Benefits

• Significant reduction or complete cessation of seizures
• Improved quality of life
• Potentially reduced need for antiepileptic medications
• Enhanced daily functioning and safety

Recovery

• Hospital stay of 3 to 7 days post-surgery
• Instructions for wound care and activity limitations
• Gradual return to normal activities over a few weeks
• Follow-up appointments for neurological assessments and imaging
• Regular monitoring for any seizure activity or complications

Alternatives

• Medication adjustments
• Vagus nerve stimulation (VNS)
• Responsive neurostimulation (RNS)
• Ketogenic diet
• Gamma knife radiosurgery
• Pros and cons of alternatives involve balancing the risk of ongoing seizures against potential surgical risks and recovery considerations.

Patient Experience

• Under anesthesia, the patient will not feel pain during the procedure.
• Post-operatively, discomfort or mild pain at the incision site is managed with pain medications.
• Possible temporary headaches or swelling.
• A recovery period where gradual improvement is expected, with close monitoring by healthcare providers.