[{"@context":"https:\/\/schema.org\/","@type":"Article","@id":"https:\/\/share-dev.upmc.com\/2021\/07\/less-invasive-brain-surgeries-for-epilepsy\/#Article","mainEntityOfPage":"https:\/\/share-dev.upmc.com\/2021\/07\/less-invasive-brain-surgeries-for-epilepsy\/","headline":"UPMC Neurosurgeons Pioneer New Less-Invasive Brain Surgeries for Epilepsy","name":"UPMC Neurosurgeons Pioneer New Less-Invasive Brain Surgeries for Epilepsy","description":"Neurosurgeons at UPMC are pioneering new less-invasive brain surgeries for people with medically refractory epilepsy that does not respond to medication.","datePublished":"2021-07-28","dateModified":"2024-09-03","author":{"@type":"Organization","@id":"https:\/\/www.upmc.com\/services\/neurosurgery-regions","name":"Neurosurgery","url":"https:\/\/www.upmc.com\/services\/neurosurgery-regions","sameAs":"https:\/\/share-dev.upmc.com\/neurosurgery\/","parentOrganization":"UPMC"},"publisher":{"@type":"Organization","name":"UPMC HealthBeat","logo":{"@type":"ImageObject","@id":"https:\/\/share-dev.upmc.com\/wp-content\/uploads\/2019\/04\/UPMC-HealthBeat-Logo.png","url":"https:\/\/share-dev.upmc.com\/wp-content\/uploads\/2019\/04\/UPMC-HealthBeat-Logo.png","width":600,"height":60}},"image":{"@type":"ImageObject","@id":"https:\/\/share-dev.upmc.com\/wp-content\/uploads\/2021\/07\/GettyImages-811280970.jpg","url":"https:\/\/share-dev.upmc.com\/wp-content\/uploads\/2021\/07\/GettyImages-811280970.jpg","height":325,"width":753},"url":"https:\/\/share-dev.upmc.com\/2021\/07\/less-invasive-brain-surgeries-for-epilepsy\/","about":["Health Topics A-Z"],"wordCount":1114,"articleBody":"Doctors at the UPMC Department of Neurosurgery are pioneering novel, less-invasive epilepsy surgeries that have fewer complications yet are effective at stopping seizures. These surgeries offer hope for the more than 1 million people living with what is known as medically refractory epilepsy \u2014 the type of seizure disorder that does not respond to medication.What is Epilepsy?Epilepsy is a condition of the brain that causes seizures. Seizures are sudden bursts of electricity that disrupt the communication between neurons in the brain. This activity can happen in one small part of the brain and last for just a few seconds, or it can spread across the brain and keep going for many minutes.Some seizures cause the body to jerk or shake, while others cause people to lose awareness or have unusual sensations. They can occur when the person is awake or asleep and, if left uncontrolled, can severely affect the person\u2019s safety and quality of life.Epilepsy by the NumbersEpilepsy is the 4th\u00a0most common neurological condition in the U.S. It affects more than 3.4 million Americans, including 470,000 children. Medication can stop seizures for about 60% of people who are living with epilepsy. But for the 40% of people whose epilepsy does not respond to medication, there have been few options.\u201cSurgery can be the next step when a patient\u2019s epilepsy fails to respond to two medications or when the medications cause debilitating side effects,\u201d says\u00a0Jorge Gonzalez-Martinez, MD, PhD, FAANS, a world-renowned neurosurgeon specializing in epilepsy and co-director of the\u00a0UPMC Comprehensive Epilepsy Center.\u201cBut, in the past, brain surgeries for epilepsy have been very invasive, often requiring removal of large portions of the skull and large resections, which led to significant complications and high morbidity.\u201dSince 2019, Dr. Gonz\u00e1lez-Mart\u00ednez has led the UPMC neurosurgery team in initiating new, less-invasive surgical interventions that enable surgeons to explore the brain. One such intervention is robotic-assisted stereo-electroencephalography (SEEG), which helps guide surgeons with the placement of thin electrodes into the brain to find exactly where the seizures are coming from. Once implanted, the electrodes record the electrical activity of the brain in a hospital epilepsy monitoring unit over 3 to 7 days.Placing the ElectrodesTo locate where the seizures are coming from, the surgeon and team need to determine where to put the electrodes. \u201cThe decision where to implant the electrodes in the brain is defined at our patient management conference by a multidisciplinary group of physicians, including neurosurgeons, neurologists, psychologists, and radiologists. The team studies the patient\u2019s history, prior EEGs, and other test results to generate a hypothesis of where the seizures are coming from,\u201d explains Dr. Gonz\u00e1lez-Mart\u00ednez.\u201cThen we design the implant map based on that information and transfer it into our robot. The robot uses a type of GPS to help us find the best routes to the parts of the brain where the activity is occurring.\u201dThe surgeon places 10 to 15 electrodes inside the brain while the patient is under sedation. Placing the electrodes lets the doctors take three steps to find where the seizures are coming from.The first step is when the electrodes passively record seizures as they happen. Doctors use the second step to pass a small amount of current into specific parts of the brain to stimulate it in an attempt to provoke a seizure, which gives the surgeons more information.Doctors use the third step when they think they\u2019ve found where the seizures come from to figure out what would happen if that part of the brain were removed. Would it affect vision? Speech? Movement? While the patient is awake (and before removing any part of the brain), the surgeon can ask them questions to monitor their speech or have them squeeze their hand to monitor movement.SEEG-guided electrode placement sounds a bit scary, but it is a very safe procedure. Dr. Gonz\u00e1lez-Mart\u00ednez reports that his team has performed more than 550 implantations of more than 7,000 electrodes with a complication rate of less than 1%.Finding the Source of the SeizuresSometimes a brain lesion will show up on MRI, so the surgeon knows where to go \u2014 but other times, the location is not so clear. This is why SEEG-guided electrode placement is so important. Surgeons use the SEEG-guided electrode placement to verify where the seizures are coming from, and can either confirm or reject the multidisciplinary team\u2019s location hypotheses. What surgeons do next depends on what they find.\u201cIf we find a large lesion, we will do an open resection and aspirate the tissue, but if we find a tiny lesion, we don\u2019t need to open the skull at all,\u201d he says. \u201cWe can just put a probe in and use thermal coagulation to ameliorate it or use the endoscopic endonasal approach.\u201dThe\u00a0endoscopic endonasal approach (EEA)\u00a0is a minimally invasive technique pioneered and refined at UPMC. It allows neurosurgeons to access the base of the skull, central brain, and top of the spine by operating through the nasal passages.\u201cEEA uses the nose and sinuses as natural corridors to access lesions in critical areas of the brain, allowing us to treat many hard-to-reach lesions without disturbing the skull,\u201d says Dr. Gonzalez-Martinez. EEA is often used to treat a variety of brain tumors.UPMC neurosurgeons have more than 25 years of experience using the EEA technique. Over the years, the team has constantly refined their skills and expanded the possible uses for this innovative approach.Giving Hope When Options Are FewNeurosurgeons at UPMC perform between 100 and 150 epilepsy surgeries each year on people of all ages and from across the country and around the world. Dr. Gonz\u00e1lez-Mart\u00ednez\u2019s team has a success rate of between 60% and 70% \u2014 meaning that these patients will no longer have seizures.\u201cThese are patients who had minimal chance of becoming seizure-free on medications,\u201d Dr. Gonz\u00e1lez-Mart\u00ednez emphasizes. \u201cAfter surgery, they go on to live healthy lives without seizures \u2014 permanently.\u201dBut what about those patients who are not candidates for surgery at all?\u201cSome of these patients can benefit from the implantation of a neuromodulation device, similar to a pacemaker, in the brain,\u201d says Dr. Gonz\u00e1lez-Mart\u00ednez. \u201cNeuromodulation can reduce the number or severity of seizures in about half of the nonsurgical group.\u201dUnfortunately, for a small subset of patients, there still is no treatment.\u201cThat is where we focus our research \u2014 so that we can eventually help them gain better functional and quality-of-life outcomes,\u201d he says.For more information about the UPMC Comprehensive Epilepsy Center or to schedule an appointment, call 833-398-0286 or\u00a0visit us online.Editor's Note: This article was originally published on July 28, 2021, and was last reviewed on September 3, 2024."},{"@context":"https:\/\/schema.org\/","@type":"BreadcrumbList","itemListElement":[{"@type":"ListItem","position":1,"name":"2021","item":"https:\/\/share-dev.upmc.com\/2021\/#breadcrumbitem"},{"@type":"ListItem","position":2,"name":"07","item":"https:\/\/share-dev.upmc.com\/2021\/\/07\/#breadcrumbitem"},{"@type":"ListItem","position":3,"name":"UPMC Neurosurgeons Pioneer New Less-Invasive Brain Surgeries for Epilepsy","item":"https:\/\/share-dev.upmc.com\/2021\/07\/less-invasive-brain-surgeries-for-epilepsy\/#breadcrumbitem"}]}]