Minimally Invasive Epilepsy Treatment

General: These procedures involve stereotactic insertion of intracranial electrodes for either 1) StereoEEG (SEEG) monitoring, or 2) Neuropace Responsive Neurostimulation (RNS). For both procedures patients witt receive general anesthesia, starting in the CT scanner, followed by in the oparating room where the leads w/wo neurostimuator will be inserted.
Preop: Two different anesthesia locations need to be set up (CT and OR). The patient will be transported anesthetized between these locations. Appropriate equipment (transport monitor, Jackson Reese system, infusion pump, emergency equipment) need to be available before indution of anesthesia. Patients will receive general anesthesia. Premedicate with up to 2 mg of midazolam.
Monitors: Routine anesthesia monitors and a foley catheter.
Anesthesia: Goals are to prevent unintended patient movement after induction of anesthesia due to the stereotactic nature of these procedures. Induction of anesthesia with propofol in the CT scanner. Fentanyl up to 5 μg /kg in divided doses throughout induction, prior to intubation. Special attention need to be paid when securing the endotracheal tube, as reintubation after head frame application is not feasible. Tape eyes and insert an esophageal temperature probe. Maintain anesthesia with oxygen, sevoflurane, propofol infusion (50-100 μg/kg/min) and additional fentanyl doses as needed. Propofol infusion during transport. Maintain appropriate level of anesthesia with or without muschle relaxation to prevent patient movement. Remember the increased metabolism for many muscle relaxants in patients taking tegretol or dilantin. Maintain euvolemia. Reverse NM relaxation and wake up and extubate the patient in the OR.
Potential complications: Potential for air embolus during burr hole and intracranial electrode placement in the OR as patient will be in a semi sitting position. Small possibility for intracranial hemorrhage during intracranial electrode placement. Multiple anesthesia locations and patient transport will have associated risks. Moving the patient with the head frame and potentially the extra-cranial parts of the electrodes needs special attention. Most patients will be on antiepileptic medications and may have increased anesthetic and NM relaxant requirements.
Recovery: Use a hemodynamic monitor and supplemental oxygen during patient transport to PACU or NICU.

Last revised 080115