Stereotactic electroencephalogram lead placement in patient with hemophilia B: illustrative case.

backgroundMany surgeons have viewed hemophilia as a relative contraindication to elective cranial procedures given the risk of intracranial hemorrhage. However, there is a growing body of literature describing the successful perioperative management of hemophilia patients, thanks to multidisciplinary collaboration between neurosurgeons, hematologists, pharmacists, and other specialists. Previous reports have described how patients with hemophilia have navigated acute neurosurgical interventions, including trauma, tumor resection, deep brain stimulation, and surgical management of epilepsy. OBSERVATIONS: In this illustrative case, a multidisciplinary care team managed a patient with medically refractory epilepsy and hemophilia B undergoing stereotactic electroencephalography (sEEG) monitoring. Their neurological status and hematological markers were closely monitored through an 11-day hospital stay in the epilepsy monitoring unit. The key pharmacological intervention was recombinant factor IX replacement titrated to factor IX assay levels. The patient remained clinically stable without any hemorrhagic complications. LESSONS: This illustrative case demonstrates a successful management strategy for sEEG placement, monitoring, and removal in a patient with hemophilia B. A multidisciplinary care strategy is integral to this model of management. https://thejns.org/doi/10.3171/CASE25892.