Brian A Tong1, Yoshua Esquenazi1, Jessica Johnson1, Ping Zhu1, Nitin Tandon2. 1. Vivian L. Smith Department of Neurosurgery, McGovern Medical School at UT Health, Houston, Texas, USA. 2. Vivian L. Smith Department of Neurosurgery, McGovern Medical School at UT Health, Houston, Texas, USA; Texas Institute of Restorative Neurotechnologies, UT Health, Houston, Texas, USA. Electronic address: Nitin.Tandon@uth.tmc.edu.
Abstract
BACKGROUND: Intracranial recordings are integral to evaluating patients with pharmacoresistant epilepsy whom noninvasive testing fails to localize seizure focus. Although stereo-electroencephalography is the preferred method of intracranial recordings in most centers, subdural electrode (SDE) implantation is necessary in selected cases. OBJECTIVE: To identify imaging correlates that predict SDE complications (extra-axial fluid collections [EFCs]), and determine if modifications that diminish stiffness of electrode sheets reduce complications. METHODS: A prospective epilepsy surgery database was used to identify adults undergoing craniotomy for SDE implantation over a 14-year period. EFCs and midline shift were measured via magnetic resonance imaging and computed tomography imaging. Correlation analyses and multivariable logistic regression explored associations between use of conformal arrays, serial order of patients, previous ipsilateral intracranial surgery, midline shift, number of SDEs, and neurologic complications. RESULTS: A total of 111 consecutive patients (59 female) underwent 117 craniotomies (mean, 115 electrode contacts) for SDE implantation. There were 8 surgical complications, 3 in the first 17 (17.7%). and 5 (after electrode modifications) in a subsequent 100 craniotomies (5.0%). We noted an increase in electrode numbers implanted over time (P < 0.001) and decreased midline shift with conformal grids (ρ = - 0.32; P < 0.001). A multivariable regression showed that midline shift correlated with complications (odds ratio, 2.32; 95% confidence interval, 1.12-4.78; P = 0.023). CONCLUSIONS: Hemorrhagic complications after SDE implantation are difficult to detect because of artifact from electrodes, but predictable by prominent midline shift (>4 mm). Risks inherent to SDE implantation may be minimized using conformal grids. With symptomatic EFCs, a single electrode cable exit site allows hematoma evacuation without terminating intracranial recordings.
BACKGROUND: Intracranial recordings are integral to evaluating patients with pharmacoresistant epilepsy whom noninvasive testing fails to localize seizure focus. Although stereo-electroencephalography is the preferred method of intracranial recordings in most centers, subdural electrode (SDE) implantation is necessary in selected cases. OBJECTIVE: To identify imaging correlates that predict SDE complications (extra-axial fluid collections [EFCs]), and determine if modifications that diminish stiffness of electrode sheets reduce complications. METHODS: A prospective epilepsy surgery database was used to identify adults undergoing craniotomy for SDE implantation over a 14-year period. EFCs and midline shift were measured via magnetic resonance imaging and computed tomography imaging. Correlation analyses and multivariable logistic regression explored associations between use of conformal arrays, serial order of patients, previous ipsilateral intracranial surgery, midline shift, number of SDEs, and neurologic complications. RESULTS: A total of 111 consecutive patients (59 female) underwent 117 craniotomies (mean, 115 electrode contacts) for SDE implantation. There were 8 surgical complications, 3 in the first 17 (17.7%). and 5 (after electrode modifications) in a subsequent 100 craniotomies (5.0%). We noted an increase in electrode numbers implanted over time (P < 0.001) and decreased midline shift with conformal grids (ρ = - 0.32; P < 0.001). A multivariable regression showed that midline shift correlated with complications (odds ratio, 2.32; 95% confidence interval, 1.12-4.78; P = 0.023). CONCLUSIONS:Hemorrhagic complications after SDE implantation are difficult to detect because of artifact from electrodes, but predictable by prominent midline shift (>4 mm). Risks inherent to SDE implantation may be minimized using conformal grids. With symptomatic EFCs, a single electrode cable exit site allows hematoma evacuation without terminating intracranial recordings.
Authors: Aura Kullmann; Debra Kridner; Steve Mertens; Mark Christianson; Dave Rosa; Camilo A Diaz-Botia Journal: Front Neurosci Date: 2022-04-29 Impact factor: 5.152
Authors: Oscar Woolnough; Cihan M Kadipasaoglu; Christopher R Conner; Kiefer J Forseth; Patrick S Rollo; Matthew J Rollo; Vatche G Baboyan; Nitin Tandon Journal: Sci Data Date: 2022-01-31 Impact factor: 6.444