Ferran Brugada-Bellsolà1, Santiago Candela-Cantó2,3, Jordi Muchart López3,4, Javier Aparicio Calvo3, Mariana Alamar Abril2, Victoria Becerra Castro2, Jordi Rumià Arboix2,3,5, Jose Hinojosa Mena-Bernal2,3. 1. Department of Neurosurgery, Hospital Universitari Germans Trias i Pujol, Universitat Autònoma de Barcelona , Ctra del Canyet sn, 08916, Barcelona, CP, Spain. fbrugada@gmail.com. 2. Department of Pediatric Neurosurgery, Sant Joan de Déu Barcelona Children's Hospital, Universitat de Barcelona, Barcelona, Spain. 3. Epilepsy Surgery Unit, Full Member of the ERN EpiCARE, Sant Joan de Déu Barcelona Children's, Universitat de Barcelona, Barcelona, Spain. 4. Diagnostic Imaging Department, Sant Joan de Déu Barcelona Children's Hospital, Universitat de Barcelona, Barcelona, Spain. 5. Department of Neurosurgery, Hospital Clinic I Provincial de Barcelona, Universitat de Barcelona, Barcelona, Spain.
Abstract
BACKGROUND: Stereo-electroencephalography (SEEG) is a well-known invasive diagnostic method for drug-resistant epilepsy (DRE). Its rate of complications is relatively low, being the intracranial hemorrhage (ICH) the most relevant. Most centers perform immediate imaging studies after SEEG to rule out complications. However, delayed intracranial hemorrhages (DIH) can occur despite normal imaging studies in the immediate postoperative period. METHODS: We performed a retrospective review of DRE pediatric patients operated on SEEG between April 2016 and December 2020 in our institution. After implantation, an immediate postoperative CT was performed to check electrode placement and rule out acute complications. An additional MRI was performed 24 h after surgery. We collected all postoperative hemorrhages and considered them as major or minor according to Wellmer´s classification. RESULTS: Overall, 25 DRE patients were operated on SEEG with 316 electrodes implanted. Three ICHs were diagnosed on postoperative imaging. Two of them were asymptomatic requiring no treatment, while the other needed surgical evacuation after clinical worsening. The total risk of hemorrhage per procedure was 12%, but just one third of them were clinically relevant. Two hemorrhages were not visible on immediate postoperative CT, being incidentally diagnosed in the 24 h MRI. We recorded them as DIH and are reported in detail. CONCLUSION: Few reports of DIH after SEEG exist in the literature. It remains unclear whether these cases are late occurring hemorrhages or immediate postoperative hemorrhages undiagnosed on initial imaging. According to our findings, we recommend to perform additional late postoperative imaging to diagnose these cases and manage them accurately.
BACKGROUND: Stereo-electroencephalography (SEEG) is a well-known invasive diagnostic method for drug-resistant epilepsy (DRE). Its rate of complications is relatively low, being the intracranial hemorrhage (ICH) the most relevant. Most centers perform immediate imaging studies after SEEG to rule out complications. However, delayed intracranial hemorrhages (DIH) can occur despite normal imaging studies in the immediate postoperative period. METHODS: We performed a retrospective review of DRE pediatric patients operated on SEEG between April 2016 and December 2020 in our institution. After implantation, an immediate postoperative CT was performed to check electrode placement and rule out acute complications. An additional MRI was performed 24 h after surgery. We collected all postoperative hemorrhages and considered them as major or minor according to Wellmer´s classification. RESULTS: Overall, 25 DRE patients were operated on SEEG with 316 electrodes implanted. Three ICHs were diagnosed on postoperative imaging. Two of them were asymptomatic requiring no treatment, while the other needed surgical evacuation after clinical worsening. The total risk of hemorrhage per procedure was 12%, but just one third of them were clinically relevant. Two hemorrhages were not visible on immediate postoperative CT, being incidentally diagnosed in the 24 h MRI. We recorded them as DIH and are reported in detail. CONCLUSION: Few reports of DIH after SEEG exist in the literature. It remains unclear whether these cases are late occurring hemorrhages or immediate postoperative hemorrhages undiagnosed on initial imaging. According to our findings, we recommend to perform additional late postoperative imaging to diagnose these cases and manage them accurately.
Authors: Pierre Bourdillon; Philippe Ryvlin; Jean Isnard; Alexandra Montavont; Hélène Catenoix; François Mauguière; Sylvain Rheims; Karine Ostrowsky-Coste; Marc Guénot Journal: World Neurosurg Date: 2016-12-19 Impact factor: 2.104
Authors: Hannah E Goldstein; Brett E Youngerman; Belinda Shao; Cigdem I Akman; Arthur M Mandel; Danielle K McBrian; James J Riviello; Sameer A Sheth; Guy M McKhann; Neil A Feldstein Journal: J Neurosurg Pediatr Date: 2018-07-20 Impact factor: 2.375