Pediatric stereoelectroencephalography (SEEG)

What is a pediatric stereoelectroencephalography (SEEG) procedure?

During SEEG, a neurosurgeon makes several small holes in your child’s skull. The surgeon implants electrodes through these holes and guides them into the brain. The electrodes then monitor your child's seizures and pinpoint where the seizures start.

SEEG is typically used for children whose seizures can’t be controlled by medication. In that case, SEEG can help decide which surgery can be used to help control the seizures.

What are the benefits of the pediatric stereoelectroencephalography (SEEG) procedure?

Traditionally, surgeons removed a relatively large section of the skull and placed electrodes directly on the brain. SEEG is a minimally invasive alternative where electrodes are implanted through several small holes. This makes the procedure safer and easier to recover from than the traditional approach.

The ROSA® robotic surgical assistant helps the surgeon place electrodes deep into the brain areas that might add to your child’s seizures. This helps us to precisely identify where seizures start. We can then surgically remove those areas if our doctors and your family decide that surgery is a good option.

While SEEG helps us in identifying the exact location the seizures come from, it doesn’t treat the seizures. SEEG does give us invaluable information on the procedure that can help your child.

What are the side effects of the pediatric stereoelectroencephalography (SEEG) procedure?

After SEEG, your child may experience a mild headache. Your child may also experience pain with chewing or difficulty opening their mouth wide. Your child’s care team will provide pain medication as needed to make your child comfortable. Almost all children feel like themselves within hours.

What are the risks of the pediatric stereoelectroencephalography (SEEG) procedure?

The risks of SEEG are minimal. Very rarely, children experience bleeding, infection or cerebrospinal fluid (CSF) leakage. Our team will carefully monitor your child during and after SEEG to keep these risks to an absolute minimum.

What are Children’s Health’s outcome metrics for the pediatric stereoelectroencephalography (SEEG) procedure?

At Children’s Health, SEEG identifies the source of seizures in 100% of children who have the procedure. While we may not be able to identify a single area that can be removed, we may be able to identify a region of the brain that may respond to a palliative procedure. These procedures can include RNS (responsive neurostimulation), deep brain stimulation (DBS) or even vagal nerve stimulation.

What to expect with the pediatric stereoelectroencephalography (SEEG) procedure?

We support you and your child before, during and after SEEG to keep them as safe and comfortable as possible.

What to expect before the pediatric stereoelectroencephalography (SEEG) procedure

Before your child comes to the hospital for SEEG, a doctor will review their health history and confirm it is safe for them to have the procedure. Your child will also have imaging tests, such as an MRI and CT scan. These tests help doctors know where to place the electrodes during SEEG.

What to expect during the pediatric stereoelectroencephalography (SEEG) procedure

Before the procedure begins, an anesthesiologist will give your child medicine to put them to sleep. Your surgeon will then shave your child’s head and save the hair for you.

Your child will be connected to the ROSA surgical robot for navigation during the procedure. The surgeon will make multiple small cuts (incisions) on the head and implant the electrodes. The SEEG procedure usually takes about four hours. Your child will not be awake or feel any pain during the procedure.

Once the doctor has placed the electrodes, your child will be woken up and moved to a recovery room. We will also perform follow-up imaging to ensure the electrodes are placed in the correct area.

What to expect after the pediatric stereoelectroencephalography (SEEG) procedure

After recovery, your child will be moved to our Epilepsy Monitoring Unit for care and monitoring. Our team will connect the electrodes to a device that records brain activity. We will carefully watch for patterns that pinpoint where your child’s seizures start. Your child will likely stay at Children’s Health for one to four weeks for monitoring, depending on how frequent your child’s seizures are.

A nurse or other provider will always be available to help your child during their stay. This ensures that the monitoring goes well and that your child stays as comfortable as possible. Your team will update you daily with the results we have gotten and those we are still waiting for.

After the monitoring is complete, the electrodes will be removed. The removal is a simple procedure that takes around 30 minutes under sedation (rather than general anesthesia) using a smaller operating room.

Your child will go home, and our team of pediatric epilepsy experts will review your child’s SEEG data to better understand their seizures and develop a treatment plan. This plan will be presented to you by either the epileptologist or your neurosurgeon. We will work with you to decide if or which surgery is still an appropriate option. If you decide to pursue surgery, your child will return several weeks after the SEEG for their procedure.

How do I prepare my child for the pediatric stereoelectroencephalography (SEEG) procedure?

Our providers will give you detailed instructions on how to prepare your child. You may also receive input from our Child Life team, which specializes in helping kids understand and manage health issues and medical procedures. Together, these providers will help you ensure that your child is medically and emotionally prepared for the SEEG procedure.

Your neurosurgeons will talk about shaving your child’s hair. They’ll also give them options for shaving their head before surgery or doing something fun like dyeing their hair a different color, shaving it in a crazy way, shaving it off with designs in the remaining hair, etc. For a young child or teen, the thought of having their head shaved can be stressful. It’s important for them to understand that it will grow back, and that this can be an opportunity to have some fun.

Seemingly small things – like explaining the procedure in terms your child can understand, and bringing a favorite blanket or stuffed animal – can make a big difference.

What is my child allowed to eat and drink before the pediatric stereoelectroencephalography (SEEG) procedure?

Your child will not be allowed to eat or drink immediately before the procedure. Our care team will give you detailed instructions on how long your child should avoid eating and drinking.

What are the prep instructions for the pediatric stereoelectroencephalography (SEEG) procedure?

You will receive clear instructions to prepare for your child’s SEEG procedure.

These instructions may include:

• Changes about how your child takes their current medicines.

• When your child needs to stop consuming food and beverage.

• Any new medicines your child needs to take before the procedure.

• A shower with special soap to reduce surgical infection

What questions should I ask my provider about the pediatric stereoelectroencephalography (SEEG) procedure?

At Children’s Health, we know that you are a critical member of your child’s care team. Therefore, it is important you understand the procedure and are comfortable with our approach and our providers. Our team is happy to answer any questions.

Here are some questions you may want to ask our care team:

• How many SEEG procedures have you performed?

• What are the risks of SEEG and how do you manage them?

• What medications should my child stop taking before the SEEG procedure?

• How soon will I be able to see my child after the SEEG procedure?

• Will you have to shave my child’s hair?

• How long do we wait after SEEG for surgery to take away my child’s seizures?