Complications and results of subdural grid electrode implantation in epilepsy surgery

Lee, Wan-su; Lee, Jung-Kyo; Lee, Sang‐Ahm; Kang, Joong-Koo; Ko, Tae‐Sung

doi:10.1016/s0090-3019(00)00324-4

Cited by 117 publications

(80 citation statements)

References 15 publications

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“…Several centers have reviewed their experience with invasive monitoring in both adults and children and have found that this technique is both safe and effective [6, 9, 11, 12, 13, 14, 15, 16, 17]. As seen in our series and others, this appears to hold true even when reevaluation with invasive monitoring is necessary after an initial invasive evaluation failed to localize the seizure focus [18].…”

Section: Discussionsupporting

confidence: 67%

Complications of Invasive Monitoring Used in Intractable Pediatric Epilepsy

2002

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Invasive monitoring for intractable epilepsy is useful when the epileptogenic focus is in question even after an extensive noninvasive presurgical evaluation, or when the epileptogenic focus is located in or near eloquent cortex. From June 1989 to June 2001 at the Children’s Hospital of Philadelphia, 64 children with intractable epilepsy underwent 67 invasive monitoring procedures as part of their presurgical evaluation. The average age at implantation was 10 years. In all but two cases, subdural strips and grids were used. Depth electrodes, when used, were placed stereotactically or under direct vision. The average duration of the monitoring period was 5.87 days. Every patient had intradural cultures sent during removal of the electrodes, and lumbar punctures were performed in 15 patients. Twenty-one patients had at least one episode of a CSF leak. Of the 67 patients, 10 had positive intradural cultures, only 1 of whom had a positive lumbar puncture and none of whom developed clinically significant meningitis. No clinically relevant hemorrhages occurred as a result of the invasive monitoring. One patient did have a transient visual field loss after placement of an occipital grid. While CSF leaks are common after invasive monitoring despite precautions, clinically significant CSF infections are uncommon and appear to be unrelated to the duration of monitoring, the occurrence of a CSF leak or the length of time the patient is on perioperative antibiotics. We conclude that invasive monitoring for intractable epilepsy is generally safe.

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Section: Discussionsupporting

confidence: 67%

Complications of Invasive Monitoring Used in Intractable Pediatric Epilepsy

2002

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“…The complication rate in this group of patients was similar to the lowest rates reported in the adult population. Our rate of infection which developed in the group of patients who underwent a second craniotomy was 6% compared to 2–15% in adult series [5,6,7,8] (table 2). Whereas we did not encounter any hemorrhage, the reported rate of hemorrhage by other groups was 0–10% [5, 6].…”

Section: Discussionmentioning

confidence: 64%

“…Most of these studies included both adult and pediatric populations in their analysis. The reported incidence of infection was 2–15%, the incidence of subdural hematoma was approximately 2%, cerebrospinal fluid (CSF) leaks occurred up to 30% of the time, and other minor rare complications included perioperative fever and atrial fibrillation [5,6,7,8]. A study has been performed on a pediatric population that also reported various complications in their patient population [5].…”

Section: Introductionmentioning

confidence: 99%

Low Incidence of Subdural Grid-Related Complications in Prolonged Pediatric EEG Monitoring

et al. 2006

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Invasive EEG monitoring is one of the best tools available for localization of epileptogenic foci in the brain. However, published data in mixed series of adult and pediatric patients show high incidence of epidural bacterial contamination, cerebrospinal fluid leakage, and skin infection after subdural electrode implantation. We sought to determine whether the complication rate from prolonged subdural electrode implantation would be lower in a purely pediatric series. Thirty-three subdural electrode implantation procedures were performed in 29 pediatric patients (age range 4–19) for an average of 7.2 days (range 3–14 days). Electrode number varied from 32 to >128 with a range of 4–11 electrode wires piercing the skin >1 cm from the primary incision. Of the 33 implantations and resections (66 craniotomies), 5 were for reimplantation. There were no permanent complications related to grid implantation. Transient complications included 1 case of prolonged prothrombin time and 1 patient with unexplained fever, both of which resolved upon removal of the grids. There were two culture-positive infections, one epidural and one superficial, both in patients undergoing reimplantation. There was no percutaneous cerebrospinal fluid leakage noted and no operation was aborted due to bleeding caused by grid placement. Our data suggest that subdural grid implantation in children is remarkably safe even for prolonged implantation, though infectious risk is significantly higher in reoperation (p = 0.019). This observation may contribute to lowering the threshold for two-stage invasive monitoring approaches in children with epilepsy.

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“…Complications of subdural recording strips such as local hemorrhage or infection are treatable and occur at a low rate [108,109]. Implantation of the recording strip in patients with brain injury was justified since clinical assessment of patients with severe brain injury is often limited as patients are frequently stuporous or comatose.…”

Section: Tbi and Spontaneous Ichmentioning

confidence: 99%

Spreading Depolarization, A Pathophysiological Mechanism of Stroke and Migraine Aura

et al. 2011

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Spreading depolarization is a mechanism of abrupt, massive ion translocation between intraneuronal and extracellular space that entails cytotoxic edema in the brain’s gray matter. It is observed in patients as a large change of the slow electrical potential. Dependent on the energy status of the tissue, spreading depolarization is either preceded by nonspreading silencing due to neuronal hyperpolarization or accompanied by spreading silencing of electrical brain activity due to a depolarization block. Nonspreading silencing seems to translate into the initial clinical symptoms of ischemic stroke and spreading silencing translates into migraine aura. Direct electrophysiological evidence exists that spreading depolarization occurs in abundance in aneurysmal subarachnoid hemorrhage, delayed ischemic stroke after subarachnoid hemorrhage, malignant hemispheric stroke, spontaneous intracerebral hemorrhage and traumatic brain injury. Indirect evidence suggests its occurrence during migraine aura. In animals, spreading depolarizations facilitate neuronal death when they invade metabolically compromised tissue, whereas they are relatively innocuous in healthy tissue. Therapies targeting spreading depolarization may potentially treat these neurological conditions.

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Complications and results of subdural grid electrode implantation in epilepsy surgery

Cited by 117 publications

References 15 publications

Complications of Invasive Monitoring Used in Intractable Pediatric Epilepsy

Complications of Invasive Monitoring Used in Intractable Pediatric Epilepsy

Low Incidence of Subdural Grid-Related Complications in Prolonged Pediatric EEG Monitoring

Spreading Depolarization, A Pathophysiological Mechanism of Stroke and Migraine Aura

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