Major and minor complications in extraoperative electrocorticography: A review of a national database

Rolston, John D.; Englot, Dario J.; Cornes, Susannah; Chang, Edward F.

doi:10.1016/j.eplepsyres.2016.02.004

Cited by 20 publications

(11 citation statements)

References 17 publications

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“…16 Recently, several groups have examined the risks associated with intracranial recordings to localize the EZ using either SEEG 8,22 or craniotomy with grid strip recordings. 3,4,17,26,27 In 2013, Cardinale et al 8 reviewed complication rates in their series of 500 SEEG electrode implantations. In this large single-center series (from an experienced center), SEEG electrode implantation-related complications were rare.…”

Section: Discussionmentioning

confidence: 99%

Frameless robot-assisted stereoelectroencephalography in children: technical aspects and comparison with Talairach frame technique

Abel

Osorio

Amorim-Leite

et al. 2018

Journal of Neurosurgery: Pediatrics

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OBJECTIVERobot-assisted stereoelectroencephalography (SEEG) is gaining popularity as a technique for localization of the epileptogenic zone (EZ) in children with pharmacoresistant epilepsy. Here, the authors describe their frameless robot-assisted SEEG technique and report preliminary outcomes and relative complications in children as compared to results with the Talairach frame–based SEEG technique.METHODSThe authors retrospectively analyzed the results of 19 robot-assisted SEEG electrode implantations in 17 consecutive children (age < 17 years) with pharmacoresistant epilepsy, and compared these results to 19 preceding SEEG electrode implantations in 18 children who underwent the traditional Talairach frame–based SEEG electrode implantation. The primary end points were seizure-freedom rates, operating time, and complication rates.RESULTSSeventeen children (age < 17 years) underwent a total of 19 robot-assisted SEEG electrode implantations. In total, 265 electrodes were implanted. Twelve children went on to have EZ resection: 4 demonstrated Engel class I outcomes, whereas 2 had Engel class II outcomes, and 6 had Engel class III–IV outcomes. Of the 5 patients who did not have resection, 2 underwent thermocoagulation. One child reported transient paresthesia associated with 2 small subdural hematomas, and 3 other children had minor asymptomatic intracranial hemorrhages. There were no differences in complication rates, rates of resective epilepsy surgery, or seizure freedom rates between this cohort and the preceding 18 children who underwent Talairach frame–based SEEG. The frameless robot-assisted technique was associated with shorter operating time (p < 0.05).CONCLUSIONSFrameless robot-assisted SEEG is a safe and effective means of identifying the EZ in children with pharmacoresistant partial epilepsy. Robot-assisted SEEG is faster than the Talairach frame–based method, and has equivalent safety and efficacy. The former, furthermore, facilitates more electrode trajectory possibilities, which may improve the localization of epileptic networks.

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Section: Discussionmentioning

confidence: 99%

Frameless robot-assisted stereoelectroencephalography in children: technical aspects and comparison with Talairach frame technique

Abel

Osorio

Amorim-Leite

et al. 2018

Journal of Neurosurgery: Pediatrics

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“…42 Though before surgical resection can proceed, the epileptic focus must be adequately localized, typically through imaging, seizure semiology, and electrophysiology. 43,44 Foci localized in noneloquent areas generally can be safely resected, and surgery provides a good chance of seizure freedom for many of these patients. 45–47 The issue becomes complicated, however, when seizure foci arise in eloquent areas, making resection untenable given the possibility of causing pronounced permanent neurological deficits.…”

Section: Discussionmentioning

confidence: 99%

Multiple Subpial Transections for Medically Refractory Epilepsy: A Disaggregated Review of Patient-Level Data

et al. 2017

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MST is an effective treatment for refractory epilepsy in eloquent cortex, with greater chances of seizure freedom when portions of the focus are resected in tandem with MST. The reported rates of seizure freedom with MST are higher than those of existing neuromodulatory therapies, such as vagus nerve stimulation, deep brain stimulation, and responsive neurostimulation, though these latter therapies are supported by randomized-controlled trials, while MST is not. The reported complication rate of MST is higher than that of resection and neuromodulatory therapies. MST remains a viable option for the treatment of eloquent foci, provided a careful risk-benefit analysis is conducted.

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“…On the other hand, there are some advantages of tracking general complications, like UTIs and cardiac events, in neurosurgical procedures, since these oftentimes are overlooked by neurosurgeons who tend to focus solely on neurological complications at the expense of other organs. For example, when looking at extra-operative ECoG case series, no article had ever reported UTI as a complication, though it appears to happen in roughly 1 in every 50 cases (Rolston et al, 2016). …”

Section: Discussionmentioning

confidence: 99%

Rate and complications of adult epilepsy surgery in North America: Analysis of multiple databases

et al. 2016

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Epilepsy surgery is under-utilized, but recent studies reach conflicting conclusions regarding whether epilepsy surgery rates are currently declining, increasing, or remaining steady. However, data in these prior studies are biased toward high-volume epilepsy centers, or originate from sources that do not disaggregate various procedure types. All major epilepsy surgery procedures were extracted from the Centers for Medicare and Medicaid Services Part B National Summary Data File and the American College of Surgeons National Surgical Quality Improvement Program. Procedure rates, trends, and complications were analyzed, and patient-level predictors of postoperative adverse events were identified. Between 2000–2013, 6200 cases of epilepsy surgery were identified. Temporal lobectomy was the most common procedure (59% of cases), and most did not utilize electrocorticography (63–64%). Neither temporal nor extratemporal lobe epilepsy surgery rates changed significantly during the study period, suggesting no change in utilization. Adverse events, including major and minor complications, occurred in 15.3% of temporal lobectomies and 55.6% of hemispherectomies. Our findings suggest stagnant rates of both temporal and extratemporal lobe epilepsy surgery across U.S. surgical centers over the past decade. This finding contrasts with prior reports suggesting a recent dramatic decline in temporal lobectomy rates at high-volume epilepsy centers. We also observed higher rates of adverse events when both low- and high-volume centers were examined together, as compared to reports from high-volume centers alone. This is consistent with the presence of a volume-outcome relationship in epilepsy surgery.

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Major and minor complications in extraoperative electrocorticography: A review of a national database

Cited by 20 publications

References 17 publications

Frameless robot-assisted stereoelectroencephalography in children: technical aspects and comparison with Talairach frame technique

Frameless robot-assisted stereoelectroencephalography in children: technical aspects and comparison with Talairach frame technique

Multiple Subpial Transections for Medically Refractory Epilepsy: A Disaggregated Review of Patient-Level Data

Rate and complications of adult epilepsy surgery in North America: Analysis of multiple databases

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