Stereo-Electroencephalography (SEEG) is a minimally invasive procedure used in the diagnostic process for people with drug-resistant epilepsy. Because SEEG involves placing electrodes inside the skull, patients often worry about surgical preparation and appearance, particularly whether a full head shave is required. This article clarifies the SEEG procedure and details the precise scalp preparation involved.
Understanding Stereo-EEG
Stereo-Electroencephalography is a diagnostic method used to pinpoint the exact origin of epileptic seizures deep within the brain. It is primarily used when non-invasive tests, such as scalp EEG and MRI, fail to clearly identify the seizure focus for potential surgical treatment. The procedure involves inserting fine wire electrodes, typically about 0.8 millimeters in diameter, into specific brain regions to record electrical activity directly from the tissue.
This technique is considered less invasive than older methods, such as placing subdural grids or strips on the brain’s surface, which required a large skull opening. SEEG allows neurosurgeons to access deeper structures in the brain, like the hippocampus or amygdala, without a large craniotomy. By recording activity from multiple targets simultaneously, SEEG provides a high-definition, three-dimensional map of seizure onset and spread. This precise localization is fundamental for determining a patient’s eligibility for curative epilepsy surgery.
The Scalp Preparation Requirement
A full head shave is generally not required for SEEG. Instead of removing all the hair, the surgical team focuses on preparing only the specific areas where the electrodes will enter the scalp. This localized preparation is a significant advantage of the minimally invasive SEEG technique.
Small patches of hair are shaved only at the planned entry points for the electrodes, which are determined by pre-operative imaging. These shaved spots are necessary to ensure a sterile field and clear access to the bone for the drilling process. A typical SEEG procedure involves implanting between 6 and 20 electrodes, meaning only those small areas of the head are cleared of hair. This technique of negligible hair shaving does not increase the risk of infection, maintaining patient safety while addressing cosmetic concerns.
The Electrode Implantation Technique
The implantation of SEEG electrodes is a highly precise neurosurgical procedure relying on advanced imaging and guidance systems. Before the operation, a surgical plan is created using fused pre-operative MRI and CT scans to define the exact three-dimensional trajectory for each electrode. This planning ensures the electrodes reach their deep-brain targets with millimeter accuracy while avoiding blood vessels.
During surgery, the patient is under general anesthesia, and a guidance system, often a robotic arm or a stereotactic frame, is used to execute the plan. At each planned entry point, a small hole is drilled through the skull, often described as being about the width of a piece of spaghetti. The thin, flexible electrode is then gently guided along the pre-determined trajectory into the targeted brain tissue. This highly controlled, minimally invasive approach minimizes the size of the required scalp opening and the overall trauma to the skull and scalp.
Immediate Post-Procedure Appearance
Following the procedure, cosmetic concerns are minimal because only small, localized areas were affected. The entry points on the scalp will look like tiny incisions, each secured with one or two small stitches or a staple. Since the rest of the hair remains intact, it can often be styled to cover these small shaved patches and incisions shortly after the procedure.
Patients typically have a light head wrap or bandage immediately following surgery to protect the electrode sites as they heal. Once the electrodes are removed, the small incisions heal to form very small scars. These scars are generally hidden by normal hair growth over time. The minimally invasive nature of SEEG means the physical changes are minor and temporary compared to the cosmetic changes associated with traditional open brain surgery.