The plan is to monitor you for about a week, but your stay could be longer, or rarely shorter. While you are in the EMU, we will gradually reduce your seizure medication in an attempt to capture seizures. You may also want to bring underwear, comfortable pants, and some personal hygiene items, although the hospital is able to provide these things to you as well. You should bring entertainment with you- books, games, computer/tablet. You will be confined to the hospital bed the entire stay except to use the bathroom. This admission will be similar to your previous EMU stay. Having the electrodes in your brain gives us a “high-definition” EEG and can provide more precise localization of your seizure onset than the scalp electrodes.
![stereo eeg stereo eeg](https://ars.els-cdn.com/content/image/1-s2.0-B9780444641960000194-f19-04a-9780444641960.jpg)
![stereo eeg stereo eeg](https://els-jbs-prod-cdn.jbs.elsevierhealth.com/cms/asset/fbfcbe57-fb61-4f20-bd23-63bd47931eb7/gr1.jpg)
![stereo eeg stereo eeg](https://neurologyindia.com/articles/2017/65/7/images/ni_2017_65_7_34_201680_f7.jpg)
The goal is to record seizures just as we did with your previous EMU admission, only this time, you will have electrodes recording from the brain itself instead of from electrodes glued to the skin. After surgery, you will get a CT scan and then be transferred to the Epilepsy Monitoring Unit (EMU). The surgery takes 1-2 hours and you will be asleep the entire time. You will not see the bolts or the electrodes as your head will be wrapped with a bandage through the entire hospital stay. Each electrode is held in place by a bolt that attaches to the bone.
STEREO EEG SKIN
To insert each electrode, we will make a small incision in the skin and a small hole in the bone, just big enough to pass the electrode. We will put the electrodes into the brain areas where we suspect seizures might be starting. These electrodes are thin, floppy wires about the thickness of a spaghetti noodle. We are going to place several (~10-15) electrodes into your brain.
STEREO EEG CODE
An analogy is that through your non-invasive testing, we have found the zip code of your seizures, but before we can proceed with surgery, we must also find the street and house number of where your seizures live. We need to do a diagnostic surgery, called SEEG, to determine the precise location.
![stereo eeg stereo eeg](https://www.seizure-journal.com/cms/attachment/2035318916/2050766499/gr2.jpg)
The testing you have had so far has helped us gather important information about where in your brain your seizures are coming from, but we have not been able to pinpoint the exact spot. He is also a pioneer of robotic-assisted neurosurgery, which improves accuracy and shortens surgery time. Gonzalez was the first epilepsy surgeon in the US to offer SEEG and has performed over 1000 cases. At UPMC, we use robotic assistance with ROSA® to accurately and efficiently place the electrodes for seizure mapping. These advancements were applied to epilepsy first by Bancaud and Talairach with their development of SEEG.4 While LITT and RNS represent more recent advancements, they are indebted to the work of Lars Leksell and Alim Benabid for their pioneering work in stereotactic ablative therapy and deep brain stimulation (DBS), respectively.SEEG is the surgical implantation of electrodes into the brain in order to better localize the seizure focus. Acquisition of pneumoencephalograms and/ or arterial angiography (developed by Dandy and Moniz, respectively) with a stereotactic reference frame enabled Spiegel and Wycis to precisely localize brain structures.3 The ability to attain sub-millimeter accuracy followed the advent of computed tomography (CT) and magnetic resonance imaging (MRI). Sir Victor Horsley, the father of modern neurosurgery, and Robert Clarke developed the first stereotactic frame in 1908, but use of the stereotactic coordinate space did not find wide use until it could be paired with intracranial imaging. While these interventions are a contemporary advancement, they are intellectually indebted to some of the most major developments and pioneers in the history of neurosurgery. Stereotactic interventions form an increasingly significant portion of the minimally invasive approaches for surgical management of epilepsy.1,2 This manuscript will review the application of three recent stereotactic techniques in the modern epilepsy surgery armamentarium, namely stereotactic electroencephalography (SEEG), responsive neural stimulation (RNS) and laser interstitial thermal therapy (LITT).