Optimizations and Nuances in Neurosurgical Technique for the Minimization of Complications in Subdural Electrode Placement for Epilepsy Surgery

Complications of subdural and depth electrodes in 269 patients undergoing 317 procedures for invasive monitoring in epilepsy

“…One major risk factor found on multivariate analysis was the placement of SGEs, which was associated with both radiographic and clinically significant extraaxial collections, as well as the development of any postoperative abnormality. This is consistent with previous studies that have suggested SGEs as a source of potential complications . Wellmer et al showed an OR of 3.69 and 4.07 for the development of postoperative complications for grid and strip assemblies or grids only, respectively.…”

“…This is consistent with previous studies that have suggested SGEs as a source of potential complications. 7,9,14 Wellmer et al 7 showed an OR of 3.69 and 4.07 for the development of postoperative complications for grid and strip assemblies or grids only, respectively. Hedegard et al 9 also showed a higher rate of complications associated with patients with SGEs (7.4%) compared with the overall population (4.8%).…”

Extratemporal resections in pediatric epilepsy surgery—an overview

“…The large exposures that are required for extensive sampling may be associated with significant blood loss, need for transfusion, greater pain and nausea, longer hospital stays, hematomas, infection, and cerebrospinal fluid (CSF) leaks . Careful surgical technique can make important differences in the safety and effectiveness of grid‐based monitoring . Depth electrodes may be useful to supplement grid‐based strategies and may be targeted with frameless navigation assistance to optimally monitor regions of suspected epileptogenesis that lie below the convexity surface .…”

“…Choice of size and configuration depends on the region to be sampled and the age of the child . Commercially available grids manufactured in North America come in a variety of sizes and shapes, and the electrodes are typically 10 mm apart on center.…”

“…Usually the distant locations are first covered—this often involves cortex beyond the edge of the craniotomy and requires delicately elevating the dura and gently sliding strip electrodes over the cortical surface. During the pass of such electrodes, careful attention is paid to any resistance encountered (typically causing subtle resistance or flexion of the strip electrode) . Such resistance typically indicates a vein, and as such should never be overcome with force .…”