Difficult-to-Localize Epilepsy After Stereoelectroencephalography: Technique, Safety, and Efficacy of Placing Additional Electrodes During the Same Admission.
Epilepsy
Functional neurosurgery
SEEG
Stereoelectroencephalography
Journal
Operative neurosurgery (Hagerstown, Md.)
ISSN: 2332-4260
Titre abrégé: Oper Neurosurg (Hagerstown)
Pays: United States
ID NLM: 101635417
Informations de publication
Date de publication:
15 12 2020
15 12 2020
Historique:
accepted:
10
08
2020
received:
30
04
2020
entrez:
14
12
2020
pubmed:
15
12
2020
medline:
22
6
2021
Statut:
ppublish
Résumé
Stereoelectroencephalography (SEEG) is used to identify the epileptogenic zone (EZ) in patients with epilepsy for potential surgical intervention. Occasionally, the EZ is difficult to localize even after an SEEG implantation. To demonstrate a safe technique for placing additional electrodes in ongoing SEEG evaluations. Describe efficacy, complications, and surgical outcomes. An operative technique which involves maintaining previously placed electrodes and sterilely placing new electrodes was developed and implemented. All patients who underwent placement of additional SEEG electrodes during the same admission were retrospectively reviewed. A total of 14 patients met criteria and had undergone SEEG evaluation with 198 electrodes implanted. A total 93% of patients (13/14) had nonlesional epilepsy. After unsuccessful localization of the EZ after a mean of 9.6 d of monitoring, each patient underwent additional placement of electrodes (5.5 average electrodes per patient) to augment the original implantation. At no point did any patients develop new hemorrhage, infection, wound breakdown, or require any kind of additional antimicrobial treatment. A total 64% (9/14) of patients were able to undergo surgery aimed at removing the EZ guided by the additional SEEG electrodes. A total 44% (4/9) of surgical patients had Engel class I outcomes at an average follow-up time of 11 mo. Placing additional SEEG electrodes, while maintaining the previously placed electrodes, appears to be safe, effective, and had no infectious complications. When confronted with difficult-to-localize epilepsy even after invasive monitoring, it appears to be safe and potentially clinically effective to place additional electrodes during the same admission.
Sections du résumé
BACKGROUND
Stereoelectroencephalography (SEEG) is used to identify the epileptogenic zone (EZ) in patients with epilepsy for potential surgical intervention. Occasionally, the EZ is difficult to localize even after an SEEG implantation.
OBJECTIVE
To demonstrate a safe technique for placing additional electrodes in ongoing SEEG evaluations. Describe efficacy, complications, and surgical outcomes.
METHODS
An operative technique which involves maintaining previously placed electrodes and sterilely placing new electrodes was developed and implemented. All patients who underwent placement of additional SEEG electrodes during the same admission were retrospectively reviewed.
RESULTS
A total of 14 patients met criteria and had undergone SEEG evaluation with 198 electrodes implanted. A total 93% of patients (13/14) had nonlesional epilepsy. After unsuccessful localization of the EZ after a mean of 9.6 d of monitoring, each patient underwent additional placement of electrodes (5.5 average electrodes per patient) to augment the original implantation. At no point did any patients develop new hemorrhage, infection, wound breakdown, or require any kind of additional antimicrobial treatment. A total 64% (9/14) of patients were able to undergo surgery aimed at removing the EZ guided by the additional SEEG electrodes. A total 44% (4/9) of surgical patients had Engel class I outcomes at an average follow-up time of 11 mo.
CONCLUSION
Placing additional SEEG electrodes, while maintaining the previously placed electrodes, appears to be safe, effective, and had no infectious complications. When confronted with difficult-to-localize epilepsy even after invasive monitoring, it appears to be safe and potentially clinically effective to place additional electrodes during the same admission.
Identifiants
pubmed: 33316815
pii: 6031862
doi: 10.1093/ons/opaa323
doi:
Types de publication
Journal Article
Langues
eng
Sous-ensembles de citation
IM
Pagination
55-60Commentaires et corrections
Type : CommentIn
Informations de copyright
Copyright © 2020 by the Congress of Neurological Surgeons.