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. 2023 Dec 11;6(24):CASE23590.
doi: 10.3171/CASE23590. Print 2023 Dec 11.

Stereoelectroencephalography in the setting of a previously implanted responsive neural stimulation device: illustrative case

Dorian M Kusyk  1 , Nicholas Blaney  2 , Timothy Quezada  3 , Alexander C Whiting  1
Affiliations

Stereoelectroencephalography in the setting of a previously implanted responsive neural stimulation device: illustrative case

Dorian M Kusyk et al. J Neurosurg Case Lessons. .

Abstract

Background: Responsive neural stimulation (RNS) is a relatively novel procedure for drug-resistant epilepsy, which involves implantation of a device into the skull and brain. As more devices are implanted, there may be an increasing need to perform intracranial electrocorticography in implant patients with persistent seizures. Given the device location, imaging difficulties with implanted devices, and other technical hurdles, stereoelectroencephalography (SEEG) could be especially challenging. The authors describe the first reported SEEG investigation in a patient with an RNS device, highlighting the technical challenges and clinical data ascertained.

Observations: A 41-year-old male with drug-resistant epilepsy presented several years after a local surgeon had placed an RNS device with two electrodes in the bilateral parieto-occipital lobes. Because of inadequate seizure control, the patient was offered a repeat SEEG investigation to characterize his epilepsy better. Although more technically challenging than a traditional SEEG implantation, the SEEG investigation was successfully performed, which led to a confirmation of bilateral hippocampal seizure onset. The patient underwent repositioning of his RNS leads with a significant decrease in his seizure frequency.

Lessons: Concurrent implantation of SEEG electrodes in a functioning RNS device can be safely performed and can augment our understanding of a patient's seizures.

Keywords: epilepsy; functional neurosurgery; responsive neural stimulation; stereoelectroencephalography.

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Conflict of interest statement

Disclosures The authors report no conflict of interest concerning the materials or methods used in this study or the findings specified in this paper.

Figures

FIG. 1
FIG. 1
Preoperative imaging. Head CT demonstrating prior RNS leads. The left lead terminates in the interior temporo-occipital lobe (A) and the right lead terminates in the parieto-occipital lobe (B). Coronal T2-weighted MRI sequence (C) showing possible left mesial temporal sclerosis.
FIG. 2
FIG. 2
A: Intraoperative photographs of patient positioning. Note the Leksell frame is positioned in such a way as to avoid the RNS implantable pulse generator (IPG) and its associated wires. B: Intraoperative photograph showing the RNS incision, the IPG, and wires marked out. C: Intraoperative fluoroscopy image with confirmation of bilateral SEEG implantation with prior RNS leads visible medially (white arrows). D: Intraoperative fluoroscopy image confirming repositioned RNS leads.
FIG. 3
FIG. 3
Example of phase 2 recordings. A: SEEG with recorded seizure onsets from the left hippocampal electrode at approximately 9:00 am. B: Long episode recording from the RNS device. Seizure onset in the left RNS lead is at approximately 09:02:10 am.
See this image and copyright information in PMC

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