Care of Patient with Stereotactic EEG Electrode Insertion

【Major Points】

Shave the hair and clean the scalp the day before surgery.
Continuous EEG monitoring will be performed after surgery to observe seizure patterns and EEG changes.
A family member should stay with the patient during the monitoring period to help prevent falls if a seizure occurs.

What is Stereotactic EEG Electrode Placement Surgery?

Stereotactic EEG electrode placement surgery is a medical procedure used to directly detect brain wave activity. Doctors place electrodes at specific locations in the brain to record both surface and deep brain wave signals. This allows for more accurate identification of problematic areas. This surgery is particularly suitable for observing multiple or widely dispersed brain lesions; it can measure brain activity from both hemispheres simultaneously, which helps support diagnosis and treatment planning.

Why is this surgery needed?

Before epilepsy surgery, patients need to go through a two-stage evaluation. (More information: Care of Patient with Epilepsy)

The first stage involves non-invasive testing, including reviewing medical history, EEG, MRI, and PET scans. If these examinations clearly identify the epileptic focus, surgery can proceed directly.
If the focus location is still unclear, doctors will proceed to invasive EEG monitoring. This involving implanting electrodes to record brain wave activity more precisely. The goal is to ensures that only the areas causing epilepsy are treated or removed, protecting the healthy brain tissue while improving surgical outcomes by significantly reducing seizure frequency.

What preparations are needed before surgery?

Surgical explanation and consent: Based on the evaluation results, the doctor will explain the purpose and process of the surgery to you and your family. You or your family will be asked to sign the necessary surgical and self-funded consent forms.
Preoperative examinations: Required tests include an electrocardiogram (ECG), chest X-ray, blood tests, Computed Tomography (CT), and Magnetic Resonance Angiography (MRA).
Keeping the scalp clean: The night before surgery, shave your head, wash your hair, and keep the scalp clean.
Medication adjustment: If you are taking anticoagulant medications (used to prevent blood clots), be sure to inform your doctor in advance. Follow instructions about when to stop taking it.
Fasting: Do not eat or drink after midnight before the surgery; if you take antiepileptic medication regularly, continue taking it with a small amount (about 30 ml) of water as instructed.
Changing into surgical gown: On the day of surgery, change into the provided surgical gown, and remove glasses (including contact lenses), dentures, nail polish, jewelry, and amulets.
Entering the operating room: On the day of surgery, the staff will accompany you to the operating room. A robotic-assisted surgical system (ROSA robotic arm) will help precisely place the EEG electrodes to ensure surgical precision.

What should I pay attention to after the surgery?

Imaging confirmation and EEG monitoring: After surgery, an MRI and skull X-ray will be performed to confirm the electrode positioning. You will then be transferred to the epilepsy monitoring ward for 7-14 days of continuous EEG monitoring (starting the next day).
Monitoring your physical condition : Watch for symptoms such as headaches, confusion, or limb weakness. If abnormalities occur, notify medical staff immediately.
Safety during monitoring: You must remain in the bed equipped with video monitoring to ensure complete recording of seizure activity. A family member must stay with you, avoid unnecessary getting out of bed, and keep the side rails up to prevent falls or injuries.
Cooperating in provoking seizures: To confirm the focus location, you may be asked to stay awake or engage in quiet but mentally stimulating activities, such as puzzles or video games. Doctors may adjust your antiepileptic medications. Follow all medication instructions carefully; do not stop or change dosages on your own.
Response during seizures onset: If you sense a seizure coming, your family members should uncover the blanket and immediately press the two call buttons by the bed to alert the nursing station and the epilepsy monitoring control center. This ensures complete recording of the brain waves and video during the seizure.
Electrode removal: After completing EEG monitoring, a second surgery will be scheduled to remove the electrodes.
Wound care: Keep the head wound clean and dry. Do not scratch or touch the wound. If redness, swelling, heat, pain, or discharge occurs, return to neurosurgery outpatient clinics for follow-up immediately.

References

Lee, C.C. (2021). Novel minimally invasive epilepsy surgery: Stereo-EEG–guided thermos coagulation of the epileptogenic zone. Clinical Medicine, 8(4), 223-229. https://doi.org/10.6666/ClinMed.202104_87(4).0036
Rohan Jha, R., Liu, D, D., Gerstl, J. V. E., Renauld, S., Kilgallon, J. L., Blitz, S. E., Medeiros, L., Nawabi, N. L. A., Singh, H., Chua, M. M. J., Tobochnik, S., Cosgrove, G. R., & Rolston, J. D. (2024). Comparative effectiveness of stereotactic, subdural, or hybrid intracranial EEG monitoring in epilepsy surgery. Journal of Neurosurgery, 141(2), 372–380. https://doi.org/10.3171/2024.1.JNS232560
Zillgitt, A. J., Mong, E. R., Manasseh, A. M., Guider, H. C., Baki, N., & Staudt, M. D. (2024). Exploration of epileptic networks in temporal lobe encephaloceles with stereotactic EEG: Electroclinical characteristics and surgical outcomes. Epilepsia Open, 9, 2395–2407. https://doi.org/10.1002/epi4.13063

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