Surgical morbidity of invasive monitoring in epilepsy surgery: an experience from a single institution

Özlen, Fatma; Asan, Ziya; Tanrıverdi, Taner; Kafadar, Ali; Özkara, Çiğdem; Özyurt, Emin; Uzan, Mustafa

doi:10.5137/1019-5149.jtn.3080-10.0

Cited by 7 publications

(19 citation statements)

References 21 publications

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“… Age (in years) and duration of invasive EEG monitoring (in days) is given as mean (range); however, two studies (Tanriverdi et al., ; and Ozlen et al., ) provided standard deviation instead. In addition, Wong et al.…”

Section: Resultsmentioning

confidence: 99%

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Adverse events related to extraoperative invasive EEG monitoring with subdural grid electrodes: A systematic review and meta‐analysis

et al. 2013

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Summary Purpose Implantation of subdural grids and invasive electroencephalography (EEG) monitoring is important to define the ictal‐onset zone and eloquent cortex in selected patients with medically refractory epilepsy. The objective of this systematic review is to summarize data about adverse events related to this procedure. Methods English‐language studies published up to July 2012, reporting such adverse events were reviewed. Outcome measures included demographic variables; surgical protocol including number of subdural electrodes implanted per patient, duration of monitoring, antibiotic, and steroid prophylaxis; and adverse events. Key Findings Twenty‐one studies were identified including a total of 2,542 patients. The reported mean number of electrodes per patient and duration of monitoring varied from 52 to 95 and 5 to 17 days, respectively. There is a trend toward more uniform use of antibiotics and steroids in the perioperative period. Neurologic infections (pooled prevalence 2.3%, 95% confidence interval 1.5–3.1), superficial infections (3.0%, 1.9–4.1), intracranial hemorrhage (4.0%, 3.2–4.8), and elevated intracranial pressure (2.4%, 1.5–3.3) were found to be the most common adverse events. Up to 3.5% of patients required additional surgical procedure(s) for management of these adverse events. Increased number of electrodes (≥67) was found to be independently associated with increased incidence of adverse events. Significance Although providing critical information for patients with medically refractory epilepsy, subdural grids implantation and invasive EEG monitoring entails risks of infection, hemorrhage, and elevated intracranial pressure. The prevalence estimates, likely to be conservative due to selective reporting, are expected to be helpful in counseling patients.

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Section: Resultsmentioning

confidence: 99%

“…The choice of antibiotic and duration of prophylaxis varied among centers. Seven studies documented using an antibiotic throughout the period of invasive EEG monitoring (Swartz et al., ; Hamer et al., ; Johnston et al., ; Fountas & Smith, ; Van Gompel et al., ; Ozlen et al., ; Blauwblomme et al., ). Wong et al.…”

Section: Resultsmentioning

confidence: 99%

Adverse events related to extraoperative invasive EEG monitoring with subdural grid electrodes: A systematic review and meta‐analysis

et al. 2013

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“…[17] MRG, PET ve interiktal EEG'nin cerrahi adayı belirlemede çok değerli olduğunu, Özlen ve ark. [8] epilepsi cerrahisinin başarı oranlarının epileptojenik odağı belirlemek için yapılan cerrahi öncesi detaylı değer-lendirmeye bağlı olduğunu bildirmişlerdir.…”

Section: Discussionunclassified

“…Epilepsi cerrahisinde başarı oranlarının epileptojenik odağı belirlemek için yapılan cerrahi öncesi değerlendirmenin doğruluğuna bağlı olduğu bildirilmiştir. [8] Epileptojenik odak, nöbetlerin başlamasın-dan sorumlu olan ve tamamen çıkarıldığında veya bağlantısı kesildiğinde hastanın nöbetsiz olmasının sağlandığı korteks bölgesi olarak tanımlanabilir. [7] Epileptojenik odağın tespiti için kullanılan testler, detaylı anamnez ile iktal semiyolojinin öğrenilmesi, interiktal elektroensefalografi (EEG), video EEG monitorizasyon (VEM), kraniyal manyetik rezonans görün-tüleme (kMRG), pozitron emisyon tomografi (PET), iktal tek foton emisyon bilgisayarlı tomografi (SPECT), nöropsikolojik değerlendirme, gerektiğinde WADA testi, fonksiyonel MRG (fMRG) ve invaziv EEG monitorizasyondan oluşmaktadır.…”

Section: Introductionunclassified

Clinical Spectrum, Seizure Outcomes, Correlation of Neuroradiology and Neuropathology, in Surgically Treated Epileptic Patients

Uysal¹,

Eroğlu²,

Erdoğan³

et al. 2013

Epilepsi

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SummaryObjectives: We aimed to investigate seizure outcomes, factors affecting these outcomes and predictive value of presurgical tests for surgical decision-making and postoperative seizure counts in patients with temporal lobe seizures. Methods: In the study, data from 47 patients (25 female, 22 male), operated for temporal lobe epilepsy between the years 1999-2010 and with at least 2 years of regular follow-were evaluated retrospectively. Patients demographic information, preoperative tests for suitability for surgery and seizure outcomes were evaluated. Results: The percentage of success in localization and lateralization of the epileptic focus was 88.6% for video EEG monitoring (VEM), 85.1% for magnetic resonance imaging (MRI) and 63.3% for positron emission tomography (PET). The rates of being seizure free for 2 years after surgery was 85.7% for patients with presurgical compatible VEM, MRI and PET results for epileptic focus, 72.7% for patients with only two of presurgical compatible results and 50% for patients with only 1 compatible result (p=0.314). 75.8% Engel Class 1 outcomes in mesial temporal sclerosis group, 92.3% in mass group were observed in second year outcomes after surgery. Conclusion:Epilepsy surgery provides high rates of probability of being seizure-free and an increase in quality of life in selected patients.Key words: Epilepsy surgery; MRI; PET; VEM. ÖzetAmaç: Temporal lob cerrahisi uygulanmış olan hastalarda nöbet sonuçlarını, cerrahi öncesi uygulanan testlerin cerrahi kararı vermede ve cerrahi sonrası nöbet sayılarını öngörmede değerleri olup olmadığı araştırıldı. Gereç ve Yöntem:1999-2010 yılları arasında epilepsi cerrahisi grubu tarafından cerrahi kararı verilen, cerrahi sonrasında da kliniğimizde en az iki yıl düzenli takipleri yapılmış 47 hasta (25 kadın, 22 erkek) geriye dönük olarak incelendi. Hastaların demografik bilgileri, cerrahi öncesi yapılan testler ve cerrahi sonrası nöbet sonuçları değerlendirildi. Bulgular: Epileptik odağı lateralize ve lokalize edebilme oranları video EEG monitörizasyon (VEM) ile %88.6, manyetik rezonans görüntüleme (MRG) ile %85.1, pozitron emisyon tomografi (PET) ile %63.3 olarak saptandı. Cerrahi öncesi her üç incelemenin epileptik odak ile uyumlu olduğu olgularda cerrahi sonrası ikinci yıl nöbetsizlik oranı %85.7 Engel 1 iken, iki incelemenin uyumlu olduğu olgularda %72.7, bir incelemenin uyumlu olduğu olgularda %50'dir (p=0.314). Cerrahi sonrası meziyal temporal skleroz grubunda %75.8, kitle grubunda ise %92.3 oranında Engel 1 ikinci yıl nöbet sonuçları tespit edildi. Sonuç:Epilepsi cerrahisi iyi seçilmiş hastalarda yüksek oranlarda nöbetsizlik, yaşam kalitesinde artma sağlamaktadır.

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“…The complication of subdural grid electrode implantation could be infection, cerebral edema, subdural and intracranial hemorrhage, epidural hematoma, CSF leak, deep vein thrombosis, status epilepticus, transient neurological deficit and even death [26][27][28]. The most frequent complication is infection and cerebral edema, these occur in up to 4 % of patient who undergo subdural grid study.…”

Section: Riskmentioning

confidence: 97%

Intracranial electrodes in the presurgical evaluation of epilepsy

2012

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The resection of the epileptogenic area of brain is very important and useful for the treatment of uncontrolled epilepsy, especially for the patients with stereotyped partial seizures. The critical point for successful epilepsy surgery is the precise identification of epileptogenic zone. Actually, we cannot precisely localize the epileptogenic zone in about 25 % of patient with refractory seizures based on the noninvasive examination; thus for these patients, we mainly use the intracranial EEG to localize the epileptogenic zone which could be useful in 10-15 % of surgical candidates. The intracranial electrodes which are most used currently are depth electrodes, subdural strip electrodes, and subdural grid electrodes. The subject of this paper is to discuss and compare the indications, construction, insertion, interpretation, limitations, risks and accuracy of each of these methods.

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Surgical morbidity of invasive monitoring in epilepsy surgery: an experience from a single institution

Cited by 7 publications

References 21 publications

Adverse events related to extraoperative invasive EEG monitoring with subdural grid electrodes: A systematic review and meta‐analysis

Adverse events related to extraoperative invasive EEG monitoring with subdural grid electrodes: A systematic review and meta‐analysis

Clinical Spectrum, Seizure Outcomes, Correlation of Neuroradiology and Neuropathology, in Surgically Treated Epileptic Patients

Intracranial electrodes in the presurgical evaluation of epilepsy

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