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Morbidity Associated With the Use of Intracranial Electrodes for Epilepsy Surgery

Published online by Cambridge University Press:  02 December 2014

Jorge G. Burneo
Affiliation:
Epilepsy Programme, Department of Clinical Neurological Sciences, London Health Sciences Centre, University of Western Ontario, London, ON, Canada
David A. Steven
Affiliation:
Epilepsy Programme, Department of Clinical Neurological Sciences, London Health Sciences Centre, University of Western Ontario, London, ON, Canada
Richard S. McLachlan
Affiliation:
Epilepsy Programme, Department of Clinical Neurological Sciences, London Health Sciences Centre, University of Western Ontario, London, ON, Canada
Andrew G. Parrent
Affiliation:
Epilepsy Programme, Department of Clinical Neurological Sciences, London Health Sciences Centre, University of Western Ontario, London, ON, Canada
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Abstract:

Background:

Invasive monitoring for the investigation of medically intractable epilepsy may be associated with undesirable morbidity. We performed a review of our recent experience to determine the incidence of major complications.

Methods:

We reviewed the clinical records of all patients who underwent invasive EEG monitoring at our institution between 2000 and 2004.

Results:

One-hundred and sixteen patients (57 males, 59 females) with a mean age of 32 years of age underwent intracranial placement of electrodes for epilepsy surgery investigation. Subdural strips were placed in 115 patients with a mean of eight strips per patient. Subdural grids were inserted in 11 patients and depth electrodes in five. Fourteen of the 15 patients with grids or depth electrodes also had strips. Coverage was unilateral in 37 patients and bilateral in 79 patients. Electrodes were placed over the frontal lobe in 78 cases, temporal in 93, parietal in 24, and occipital in 27 patients. The average duration of investigation was 12.3 days (range 3-29). The evaluation led to the performance of a surgical resection in 85 patients (74%). Complications were seen in four patients with subdural strips (3%), and in two patients with grids (13%), characterized by clinical infection, intracranial hemorrhage, aseptic meningitis, transient neurological deficits, and status epilepticus. Mortality was nil.

Conclusion:

In comparison with previously published literature on the topic, the major complication rate in this group of patients appears to be low.

Résumé:

RÉSUMÉ: Contexte:

La surveillance effractive dans l’évaluation de l’épilepsie réfractaire au traitement médical pourrait être associée à une morbidité regrettable. Nous avons revu notre experience récente pour déterminer l’incidence de complications majeures.

Méthodes:

Nous avons révisé le dossier clinique de tous les patients qui ont subi une surveillance ÉEG effractive dans notre institution entre 2000 et 2004.

Résultats:

On a implanté des électrodes intracrâniennes dans le cadre d’une évaluation pour chirurgie de l’épilepsie chez cent seize patients (57 hommes et 59 femmes) dont l’âge moyen était de 32 ans. Des électrodes sous-duales ont été placées chez 115 patients, soit en moyenne 8 électrodes par patient. Une grille d’électrodes sous-durales a été placée chez 11 patients et des électrodes profondes chez 5 patients. Quatorze des 15 patients avec une grille d’électrodes ou des électrodes profondes avaient également des electrodes en bandes. Le champ d’application était unilatéral chez 37 patients et bilatéral chez 79 patients. Les électrodes étaient placées au lobe frontal chez 78 patients, au lobe temporal chez 93, au lobe pariétal chez 24 et au lobe occipital chez 27. La durée moyenne de l’évaluation était de 12,3 jours (écart de 3 à 29 jours). L’évaluation a mené à une résection chirurgicale chez 85 patients (74%). Quatre patients qui avaient des bandes sous-durales (3%) et deux patients qui avaient des grilles (13%) ont présenté des complications, soit une infection clinique, une hémorragie intracrânienne, une méningite aseptique, des déficits neurologiques transitoires et un état de mal épileptique. Il n’y a eu aucun décès.

Conclusion:

Le taux de complications majeures chez ce groupe de patients semble bas comparé à ce qu’on retrouve dans la littérature sur ce sujet.

Type
Original Articles
Copyright
Copyright © The Canadian Journal of Neurological 2006

References

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