A Retrospective Analysis of Stereoelectroencephalography and Subdural Electroencephalography for Preoperative Evaluation of Intractable Epilepsy

Yang, Meihua; Ma, Yuanshi; Li, Wei; Shi, Xianjun; Hou, Zhi; Zhang, Chunqing; Yang, Hui; Zhang, Dong; Liu, Shiyong

doi:10.1159/000453275

Cited by 22 publications

(25 citation statements)

References 27 publications

(41 reference statements)

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“…Similarly, the complication rates for SEEG were lower. Similarly, in Yang et al study of 48 patients monitored with SEEG and 52 patients monitored with SDE, there was no statistical difference between seizure outcomes, but fewer complications with SEEG.…”

Section: Discussionmentioning

confidence: 87%

Method of invasive monitoring in epilepsy surgery and seizure freedom and morbidity: A systematic review

et al. 2019

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Objective Invasive monitoring is sometimes necessary to guide resective surgery in epilepsy patients, but the ideal method is unknown. In this systematic review, we assess the association of postresection seizure freedom and adverse events in stereoelectroencephalography (SEEG) and subdural electrodes (SDE). Methods We searched three electronic databases (MEDLINE, Embase, and CENTRAL [Cochrane Central Register of Controlled Trials]) from their inception to January 2018 with the keywords “electroencephalography,” “intracranial grid,” and “epilepsy.” Studies that presented primary quantitative patient data for postresection seizure freedom with at least 1 year of follow‐up or complication rates of SEEG‐ or SDE‐monitored patients were included. Two trained investigators independently collected data from eligible studies. Weighted mean differences (WMDs) with 95% confidence interval (CIs) were used as a measure of the association of SEEG or SDE with seizure freedom and with adverse event outcomes. Results Of 11 462 screened records, 48 studies met inclusion criteria. These studies reported on 1973 SEEG patients and 2036 SDE patients. Our systematic review revealed SEEG was associated with 61.0% and SDE was associated with 56.4% seizure freedom after resection (WMD = +5.8%, 95% CI = 4.7‐6.9%, P = .001). Furthermore, SEEG was associated with 4.8% and SDE was associated with 15.5% morbidity (WMD = −10.6%, 95% CI = −11.6 to −9.6%, P = .001). SEEG was associated with 0.2% mortality and SDE was associated with 0.4% mortality (WMD = −0.2%, 95% CI = −0.3 to −0.1%, P = .001). Significance In this systematic review of SEEG and SDE invasive monitoring techniques, SEEG was associated with fewer surgical resections yet better seizure freedom outcomes in those undergoing resections. SEEG was also associated with lower mortality and morbidity than SDE. Clinical studies directly comparing these modalities are necessary to understand the relative rates of seizure freedom, morbidity, and mortality associated with these techniques.

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Section: Discussionmentioning

confidence: 87%

Method of invasive monitoring in epilepsy surgery and seizure freedom and morbidity: A systematic review

et al. 2019

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“…This study was not included in the meta-analysis, but overlaps with earlier research [ 32 ]. Recent research by Yang et al [ 88 ] shows a global complication rate of 16.7%, with a complication rate for hemorrhage and infection of 4.2%. A very recent study by Bourdillon et al [ 12 ] reports a major complication rate of 1.52% and a minor complication rate of 2.09%.…”

Section: Discussionmentioning

confidence: 99%

Methodology, outcome, safety and in vivo accuracy in traditional frame-based stereoelectroencephalography

et al. 2017

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BackgroundStereoelectroencephalography (SEEG) is an established diagnostic technique for the localization of the epileptogenic zone in drug-resistant epilepsy. In vivo accuracy of SEEG electrode positioning is of paramount importance since higher accuracy may lead to more precise resective surgery, better seizure outcome and reduction of complications.ObjectiveTo describe experiences with the SEEG technique in our comprehensive epilepsy center, to illustrate surgical methodology, to evaluate in vivo application accuracy and to consider the diagnostic yield of SEEG implantations.MethodsAll patients who underwent SEEG implantations between September 2008 and April 2016 were analyzed. Planned electrode trajectories were compared with post-implantation trajectories after fusion of pre- and postoperative imaging. Quantitative analysis of deviation using Euclidean distance and directional errors was performed. Explanatory variables for electrode accuracy were analyzed using linear regression modeling. The surgical methodology, procedure-related complications and diagnostic yield were reported.ResultsSeventy-six implantations were performed in 71 patients, and a total of 902 electrodes were implanted. Median entry and target point deviations were 1.54 mm and 2.93 mm. Several factors that predicted entry and target point accuracy were identified. The rate of major complications was 2.6%. SEEG led to surgical therapy of various modalities in 53 patients (69.7%).ConclusionsThis study demonstrated that entry and target point localization errors can be predicted by linear regression models, which can aid in identification of high-risk electrode trajectories and further enhancement of accuracy. SEEG is a reliable technique, as demonstrated by the high accuracy of conventional frame-based implantation methodology and the good diagnostic yield.

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“…In a large pediatric series, Blauwblomme et al [6] reviewed 95 SDG investigations, finding that 29.8% of patients suffered a complication prolonging their hospital stay, 17.9% required unplanned reoperation, 16.8% developed subdural hemorrhage, and 14.7% developed a wound infection. Yang et al [96] performed an institutional study comparing outcomes from SDG (n=52) and SEEG (n=48), observing higher rates of ICH and surgical site infection among SDG patients. In a meta-analysis comparing SDG and SEEG, Sacino et al [84] reviewed 23 papers featuring 974 children (SDG, 697; SEEG, 277), finding that SDG cases had a higher pooled-prevalence of CSF leak, infection, and ICH, as well as a lower overall seizure-freedom rate (SDG, 52.1% vs. SEEG, 66.5%).…”

Section: Safety Accuracy and Efficacymentioning

confidence: 99%

Stereoelectroencephalography in Pediatric Epilepsy Surgery

Tomlinson

Buch

Armstrong

et al. 2019

J Korean Neurosurg Soc

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Stereoelectroencephalography (SEEG) is an invasive technique used during the surgical management of medically refractory epilepsy. The utility of SEEG rests in its ability to survey the three-dimensional organization of the epileptogenic zone as well as nearby eloquent cortices. Once concentrated to specialized centers in Europe and Canada, the SEEG methodology has gained worldwide popularity due to its favorable morbidity profile, superior coverage of deep structures, and ability to perform multilobar explorations without the need for craniotomy. This rapid shift in practice represents both a challenge and an opportunity for pediatric neurosurgeons familiar with the subdural grid approach. The purpose of this review is to discuss the indications, technique, and safety of long-term SEEG monitoring in children. In addition to reviewing the conceptual and technical points of the diagnostic evaluation, attention will also be given to SEEG-based interventions (e.g., radiofrequency thermo-coagulation).

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A Retrospective Analysis of Stereoelectroencephalography and Subdural Electroencephalography for Preoperative Evaluation of Intractable Epilepsy

Cited by 22 publications

References 27 publications

Method of invasive monitoring in epilepsy surgery and seizure freedom and morbidity: A systematic review

Method of invasive monitoring in epilepsy surgery and seizure freedom and morbidity: A systematic review

Methodology, outcome, safety and in vivo accuracy in traditional frame-based stereoelectroencephalography

Stereoelectroencephalography in Pediatric Epilepsy Surgery

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