Stereo-EEG (sEEG)
Stereo-EEG is a minimally invasive procedure that uses robot-assisted, image-guided placement of thin depth electrodes to pinpoint exactly where seizures begin — information that makes epilepsy surgery safer and more precise.
Epilepsy surgery pathway
From evaluation to long-term seizure care
Evaluation
Review history, imaging, EEG results, and medication response.
SEEG and mapping
Use video-EEG, imaging, and sEEG when needed to localize where seizures begin, how they spread, and what functions are nearby.
Decision
Choose resection, ablation, neuromodulation, further mapping, or non-surgical care.
Treatment
Carry out the selected procedure with a plan for safety, recovery, and seizure goals.
Follow-up
Track seizure control, medications, recovery, mood, and device settings when needed.
Precision mapping
MRI, video-EEG, neuropsychology, and sEEG when deeper localization is needed.
Tailored treatment
Resection, laser ablation, or neuromodulation selected around seizure anatomy and goals.
Long-term planning
Device programming, follow-up, and medication strategy coordinated with the epilepsy team.
Overview
Stereo-EEG (sEEG) is a minimally invasive way to find exactly where seizures begin. Thin depth electrodes are placed into carefully planned locations in the brain, typically using robot-assisted stereotactic guidance, and record activity over several days while seizures are captured. The result is a precise three-dimensional map of seizure onset that makes any subsequent surgery safer and more targeted.
Who it is for
sEEG is used when non-invasive tests — MRI and scalp video-EEG — cannot fully localize the seizure focus, or when the seizure source is deep or near critical areas. It is part of the evaluation for drug-resistant epilepsy, not a treatment by itself.
sEEG can be especially useful when seizures may arise from deep structures, from more than one possible region, or from an area close to language, memory, movement, vision, or sensation. The goal is to test a carefully developed hypothesis about where seizures start.
How the procedure works
Using image guidance, stereotactic planning, and a robotic platform, Dr. Barone places several thin electrodes through tiny openings in the skull into the target regions. The robot helps deliver each electrode along the planned trajectory with high precision. There is no large craniotomy. The electrodes are connected to monitoring equipment, and you remain in a specialized epilepsy unit while seizures are recorded.
The electrode plan is individualized. Some electrodes sample deep brain structures; others sample cortical regions along a suspected seizure pathway. The number and location of electrodes depend on the patient’s MRI, scalp EEG, seizure semiology, neuropsychology, and other test results.
What to expect
- Robot-assisted, image-guided minimally invasive placement
- A monitoring period (usually several days) to capture seizures
- Continuous review by the epilepsy team
- Removal of the electrodes once enough information is gathered
- Temporary medication adjustment in selected patients to help record typical seizures
- Activity restrictions while the electrodes are in place
- Video monitoring and safety precautions during the admission
After enough information is collected, the electrodes are removed. The team then reviews whether the data support resection, laser ablation, neuromodulation, another mapping step, or no surgical treatment.
Risks
As with any neurosurgical procedure, there are risks, including a small chance of bleeding, infection, headache, neurologic change, or seizure-related injury during monitoring. Because sEEG avoids a large skull opening, it is generally well tolerated. Your specific risks are reviewed in detail beforehand.
Dr. Barone’s approach
Dr. Barone is fellowship-trained in functional and epilepsy neurosurgery and uses sEEG to give patients the most accurate possible answer about where their seizures begin — and the safest path forward.
Frequently asked questions
What is stereo-EEG (sEEG)? +
Stereo-EEG is a procedure in which several thin depth electrodes are placed through tiny openings in the skull into precisely planned locations in the brain, often using a robotic stereotactic platform for accuracy. They record electrical activity over several days to map exactly where seizures start and how they spread, without a large opening in the skull.
Is sEEG brain surgery? +
sEEG is a minimally invasive neurosurgical procedure. The electrodes are placed stereotactically through small holes rather than by removing a section of skull, which generally means less discomfort and a faster recovery than older grid-based methods.
Why is sEEG needed before epilepsy surgery? +
When imaging and scalp EEG cannot fully localize where seizures begin, sEEG provides direct, high-resolution recordings from inside the brain. This precise map allows the surgical team to plan the safest, most effective treatment — and sometimes to confirm that surgery can be avoided.
What happens after the recordings? +
Once enough seizures are recorded, the electrodes are removed and the team reviews the data. The findings guide the next step, which may be resective surgery, laser ablation, or neuromodulation. Some targets identified by sEEG can even be treated during the same monitoring period.
Patient story
Janet's epilepsy surgery journey
A Houston Methodist video follows Janet through sEEG mapping, temporal lobectomy, and life after epilepsy surgery.
Janet's outcome is one patient's experience; every epilepsy surgery evaluation is individualized.
Considering treatment for Stereoelectroencephalography?
Dr. Barone evaluates new patients and referrals at Houston Methodist Hospital, Houston. Patients from outside Houston, across the United States, and internationally are welcome.