Risk factors for complications during intracranial electrode recording in presurgical evaluation of drug resistant partial epilepsy

• Published in: Acta neurochirurgica 2009, Vol.151 (1), p.37-50
• Main Authors: Wong, Chong H., Birkett, Julie, Byth, Karen, Dexter, Mark, Somerville, Ernest, Gill, Deepak, Chaseling, Ray, Fearnside, Michael, Bleasel, Andrew
• Format: Article
• Language: English
• Subjects: Adolescent; Adult; Brain Infarction - etiology; Brain Infarction - physiopathology; Brain Infarction - prevention & control; Cerebral Cortex - physiopathology; Cerebral Cortex - surgery; Clinical Article; Drug Resistance - physiology; Electrodes; Electrodes, Implanted - adverse effects; Electrodes, Implanted - standards; Electroencephalography - adverse effects; Electroencephalography - instrumentation; Electroencephalography - methods; Epilepsies, Partial - diagnosis; Epilepsies, Partial - physiopathology; Epilepsies, Partial - surgery; Epilepsy; Equipment Contamination - prevention & control; Equipment Contamination - statistics & numerical data; Female; Hematoma, Subdural - etiology; Hematoma, Subdural - physiopathology; Hematoma, Subdural - prevention & control; Humans; Interventional Radiology; Male; Medicine; Medicine & Public Health; Minimally Invasive Surgery; Monitoring, Physiologic - adverse effects; Monitoring, Physiologic - instrumentation; Monitoring, Physiologic - methods; Neurology; Neuroradiology; Neurosurgery; Neurosurgical Procedures - statistics & numerical data; Osteomyelitis - etiology; Osteomyelitis - physiopathology; Osteomyelitis - prevention & control; Postoperative Complications - etiology; Postoperative Complications - physiopathology; Postoperative Complications - prevention & control; Preoperative Care - adverse effects; Preoperative Care - instrumentation; Preoperative Care - methods; Retrospective Studies; Risk Assessment; Surgery; Surgical Orthopedics; Surgical Wound Infection - physiopathology; Surgical Wound Infection - prevention & control; Treatment Outcome; Young Adult
• ISSN: 0001-6268; 0942-0940
• DOI: 10.1007/s00701-008-0171-7

Background Intracranial electrode monitoring is still required in epilepsy surgery; however, it is associated with significant morbidity. Objective To identify risk factors associated with complications during invasive intracranial EEG monitoring. Materials and methods Retrospective study of all patients undergoing invasive monitoring at Westmead between 1988–2004. From detailed chart reviews, the following variables were recorded: duration of intracranial monitoring, the site of grid implantation, number of grids and electrodes, seizure frequency, postoperative complications and seizure outcome. Results Seventy-one patients (median age: 24 years) underwent subdural electrode implantation; 62% had extratemporal lobe epilepsy and 46% were non-lesional. Of the 58 monitored patients who had cortical resections, 45 had good seizure outcomes. Complications related to subdural electrode implantation included transient complications requiring no treatment (12.7%), transient complications requiring treatment (9.9%) and two deaths (2.8%). Specific complications included subdural haemorrhage, transient neurological deficit, infarction and osteomyelitis. The two deaths occurred within 48 h of implantation were related to raised intracranial pressure (one venous infarction, one unexplained). Complications were associated with maximal size of grid ( p