Morbidity and infection in combined subdural grid and strip electrode investigation for intractable epilepsy

Wiggins, Gregory C.; Elisevich, Kost; Smith, Brien

doi:10.1016/s0920-1211(99)00037-6

Cited by 83 publications

(58 citation statements)

References 28 publications

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“…Several centers have reviewed their experience with invasive monitoring in both adults and children and have found that this technique is both safe and effective [6, 9, 11, 12, 13, 14, 15, 16, 17]. As seen in our series and others, this appears to hold true even when reevaluation with invasive monitoring is necessary after an initial invasive evaluation failed to localize the seizure focus [18].…”

Section: Discussionsupporting

confidence: 67%

“…There was no significant correlation in our series between positive intradural cultures and the number of craniotomies performed at the time of implantation, surgical time of implantation, duration of monitoring, the occurrence of a CSF leak or the length of the hospital stay. However, Wiggins et al [11], reporting on a series of 38 patients who underwent invasive monitoring, did find that positive epidural cultures correlated with the use of greater than 100 electrodes, more than 10 cables, more than 14 days of implantation and more than one cable exit site.…”

Section: Discussionmentioning

confidence: 99%

“…Because epilepsy surgery is nearly always elective, both the physician and patient’s family should have a thorough understanding of the risks of invasive monitoring prior to surgery. Several studies have reported complications resulting from invasive monitoring [6, 8, 9, 10, 11]. The present study reports a 12-year experience with invasive monitoring in a single pediatric center during which rigorous protocols for monitoring infectious and neurologic complications were followed.…”

Section: Introductionmentioning

confidence: 99%

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Complications of Invasive Monitoring Used in Intractable Pediatric Epilepsy

2002

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Invasive monitoring for intractable epilepsy is useful when the epileptogenic focus is in question even after an extensive noninvasive presurgical evaluation, or when the epileptogenic focus is located in or near eloquent cortex. From June 1989 to June 2001 at the Children’s Hospital of Philadelphia, 64 children with intractable epilepsy underwent 67 invasive monitoring procedures as part of their presurgical evaluation. The average age at implantation was 10 years. In all but two cases, subdural strips and grids were used. Depth electrodes, when used, were placed stereotactically or under direct vision. The average duration of the monitoring period was 5.87 days. Every patient had intradural cultures sent during removal of the electrodes, and lumbar punctures were performed in 15 patients. Twenty-one patients had at least one episode of a CSF leak. Of the 67 patients, 10 had positive intradural cultures, only 1 of whom had a positive lumbar puncture and none of whom developed clinically significant meningitis. No clinically relevant hemorrhages occurred as a result of the invasive monitoring. One patient did have a transient visual field loss after placement of an occipital grid. While CSF leaks are common after invasive monitoring despite precautions, clinically significant CSF infections are uncommon and appear to be unrelated to the duration of monitoring, the occurrence of a CSF leak or the length of time the patient is on perioperative antibiotics. We conclude that invasive monitoring for intractable epilepsy is generally safe.

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Section: Discussionsupporting

confidence: 67%

Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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Complications of Invasive Monitoring Used in Intractable Pediatric Epilepsy

2002

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“…Only the former complication has been reported in the literature [7]. The noninfected patients recovered quickly postoperatively and their seizure frequency improved in over 80% of the series [7]. …”

Section: Resultsmentioning

confidence: 99%

“…Most of these studies included both adult and pediatric populations in their analysis. The reported incidence of infection was 2–15%, the incidence of subdural hematoma was approximately 2%, cerebrospinal fluid (CSF) leaks occurred up to 30% of the time, and other minor rare complications included perioperative fever and atrial fibrillation [5,6,7,8]. A study has been performed on a pediatric population that also reported various complications in their patient population [5].…”

Section: Introductionmentioning

confidence: 99%

Low Incidence of Subdural Grid-Related Complications in Prolonged Pediatric EEG Monitoring

et al. 2006

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Invasive EEG monitoring is one of the best tools available for localization of epileptogenic foci in the brain. However, published data in mixed series of adult and pediatric patients show high incidence of epidural bacterial contamination, cerebrospinal fluid leakage, and skin infection after subdural electrode implantation. We sought to determine whether the complication rate from prolonged subdural electrode implantation would be lower in a purely pediatric series. Thirty-three subdural electrode implantation procedures were performed in 29 pediatric patients (age range 4–19) for an average of 7.2 days (range 3–14 days). Electrode number varied from 32 to >128 with a range of 4–11 electrode wires piercing the skin >1 cm from the primary incision. Of the 33 implantations and resections (66 craniotomies), 5 were for reimplantation. There were no permanent complications related to grid implantation. Transient complications included 1 case of prolonged prothrombin time and 1 patient with unexplained fever, both of which resolved upon removal of the grids. There were two culture-positive infections, one epidural and one superficial, both in patients undergoing reimplantation. There was no percutaneous cerebrospinal fluid leakage noted and no operation was aborted due to bleeding caused by grid placement. Our data suggest that subdural grid implantation in children is remarkably safe even for prolonged implantation, though infectious risk is significantly higher in reoperation (p = 0.019). This observation may contribute to lowering the threshold for two-stage invasive monitoring approaches in children with epilepsy.

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Invasive EEG in Presurgical Evaluation of Epilepsy

and¹,

Spencer²

2004

The Treatment of Epilepsy

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Morbidity and infection in combined subdural grid and strip electrode investigation for intractable epilepsy

Cited by 83 publications

References 28 publications

Complications of Invasive Monitoring Used in Intractable Pediatric Epilepsy

Complications of Invasive Monitoring Used in Intractable Pediatric Epilepsy

Low Incidence of Subdural Grid-Related Complications in Prolonged Pediatric EEG Monitoring

Invasive EEG in Presurgical Evaluation of Epilepsy

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