Afsaneh Talai1, Krista Eschbach2, Nicholas V Stence3, Claire Palmer4, Wynne Bird5, Allyson Alexander6, Brent R O'Neill7, Kevin E Chapman5, Charuta Joshi5. 1. Children's Hospital Colorado, University of Colorado Denver, Anschutz School of Medicine, Department of Pediatrics, Section of Neurology, 13123 E 16th Avenue, Box 155, Aurora, CO 80045, United States. Electronic address: Afsaneh.talai@utsouthwestern.edu. 2. Children's Hospital Colorado, University of Colorado Denver, Anschutz School of Medicine, Department of Pediatrics, Section of Neurology, 13123 E 16th Avenue, Box 155, Aurora, CO 80045, United States. Electronic address: krista.eschbach@childrenscolorado.org. 3. Children's Hospital Colorado, University of Colorado Denver, Anschutz School of Medicine, Department of Radiology, 13123 E 16th Avenue, Box 125, Aurora, CO 80045, United States. Electronic address: nicholas.stence@cuanschutz.edu. 4. Children's Hospital Colorado, University of Colorado Denver, Anschutz School of Medicine, Department of Pediatrics, 13123 E 16th Avenue, Aurora, CO 80045, United States. Electronic address: claire.levek@cuanschutz.edu. 5. Children's Hospital Colorado, University of Colorado Denver, Anschutz School of Medicine, Department of Pediatrics, Section of Neurology, 13123 E 16th Avenue, Box 155, Aurora, CO 80045, United States. 6. Children's Hospital Colorado, University of Colorado Denver, Anschutz School of Medicine, Department of Pediatric Neurosurgery, 13123 E 16th Avenue, Box 330, Aurora, CO 80045, United States. Electronic address: Allyson.Alexander@childrenscolorado.org. 7. Children's Hospital Colorado, University of Colorado Denver, Anschutz School of Medicine, Department of Pediatric Neurosurgery, 13123 E 16th Avenue, Box 330, Aurora, CO 80045, United States. Electronic address: Brent.O'Neill@childrenscolorado.org.
Abstract
OBJECTIVE: To compare adverse events and outcomes between stereoelectroencephalography (SEEG) and subdural electrode (SDE) implantation in children. METHODS: This was a retrospective analysis of 108 patients who underwent intracranial monitoring with SEEG or SDE implantation at Children's Hospital Colorado between January 2011 and June 2019. RESULTS: There were 47 patients who underwent 53 SEEG implantations and 61 patients who underwent 64 SDE implantations, with an average age of 12.45 years (range: 1.22-19.96 years). Post-implantation imaging was performed in all SEEG implantations and 42 SDE implantations. 38 % and 88 % of SEEG and SDE implantations, respectively, had a hemorrhage of any kind (p < 0.01). Clinically significant hemorrhages did not differ between the two groups, though one death was reported in the SEEG group. No patient undergoing SEEG implantation received blood products compared to 20 % of SDE patients (p < 0.01). The rate of infection in SEEG patients was 4% compared to 33 % for SDE patients (p = 0.01). Resection was completed in 60 % of SEEG patients versus 93 % for SDE patients (p < 0.01). Rate of seizure response was not significantly different between the two groups, with 81 % and 71 % of SEEG and SDE patients, respectively, reaching Engel class I or II at 12 months (p = 0.76). SIGNIFICANCE: In pediatric patients at a single institution, SEEG is associated with less adverse effects overall yet similar rates of seizure freedom compared to SDE implantation. This includes significantly lower rates of asymptomatic hemorrhage, infection and need for blood transfusion associated with SEEG monitoring. There was no statistical difference in clinically significant hemorrhages between the two groups, although rare in both.
OBJECTIVE: To compare adverse events and outcomes between stereoelectroencephalography (SEEG) and subdural electrode (SDE) implantation in children. METHODS: This was a retrospective analysis of 108 patients who underwent intracranial monitoring with SEEG or SDE implantation at Children's Hospital Colorado between January 2011 and June 2019. RESULTS: There were 47 patients who underwent 53 SEEG implantations and 61 patients who underwent 64 SDE implantations, with an average age of 12.45 years (range: 1.22-19.96 years). Post-implantation imaging was performed in all SEEG implantations and 42 SDE implantations. 38 % and 88 % of SEEG and SDE implantations, respectively, had a hemorrhage of any kind (p < 0.01). Clinically significant hemorrhages did not differ between the two groups, though one death was reported in the SEEG group. No patient undergoing SEEG implantation received blood products compared to 20 % of SDE patients (p < 0.01). The rate of infection in SEEG patients was 4% compared to 33 % for SDE patients (p = 0.01). Resection was completed in 60 % of SEEG patients versus 93 % for SDE patients (p < 0.01). Rate of seizure response was not significantly different between the two groups, with 81 % and 71 % of SEEG and SDE patients, respectively, reaching Engel class I or II at 12 months (p = 0.76). SIGNIFICANCE: In pediatric patients at a single institution, SEEG is associated with less adverse effects overall yet similar rates of seizure freedom compared to SDE implantation. This includes significantly lower rates of asymptomatic hemorrhage, infection and need for blood transfusion associated with SEEG monitoring. There was no statistical difference in clinically significant hemorrhages between the two groups, although rare in both.
Authors: Alvin Y Chan; Brian V Lien; Nolan J Brown; Julian Gendreau; Ryan S Beyer; Chen Yi Yang; Elliot H Choi; Frank P K Hsu; Sumeet Vadera Journal: Ann Med Surg (Lond) Date: 2022-07-09