The minimally invasive grid approach for seizure localization: patient series.

BACKGROUND: Epilepsy surgery continues to advance new minimally invasive techniques for both seizure localization and treatment. Stereo-electroencephalography (sEEG) is increasingly being used; however, some patients continue to require subdural electrodes for neocortical mapping. Traditional subdural grid electrodes involve medium to large craniotomies, relatively large incisions, and can be associated with morbidity. The authors describe a minimally invasive technique using a small, strip-like craniotomy and sequentially placed subdural strips to form a minimally invasive subdural grid (MIG) for seizure localization. OBSERVATIONS: Eight patients underwent electrode placement using a MIG in combination with stereotactic depth electrodes. Small craniotomies, typically positioned several centimeters away from the targeted region, allowed insertion of parallel strip electrodes under stereotactic navigation to create a grid-like array. Postoperative imaging confirmed electrode positioning and allowed for adjustments. LESSONS: The MIG technique successfully localized epileptogenic zones without major complications and was effectively used for stimulation-based mapping. No patient developed subdural fluid collection over the grid site, hemorrhage, or significant CSF leakage. The MIG technique significantly minimized the surgical incision and craniotomy size required for equivalent neocortical surface coverage. The MIG technique offers a safe, minimally invasive alternative for seizure localization and mapping while reducing craniotomy size. https://thejns.org/doi/10.3171/CASE25981.