Morbidity of Chronic Recording with Intracranial Depth Electrodes in 170 Patients

Espinosa, José Antonio Camacho; Olivier, A; Andermann, F.; Quesney, F; Dubeau, F.; Savard, Ghislaine

doi:10.1159/000100293

Cited by 36 publications

(33 citation statements)

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“…The rate of 4.3% for clinically significant complications is comparable with previous findings (7,8,13,15). Because IDEs and SESs were generally inserted together, it was difficult to assign the complications to either IDE or SES implantation.…”

Section: No Impairment Of Verbal Memory and Learningsupporting

confidence: 83%

“…Furthermore, functional deficits may result from structural damage, especially if electrodes are inserted into a brain area that will not be resected (8,lO). All reports on safety profiles of depth electrodes have been limited to the assessment of neurologic complications and imaging findings (3,8,10,(13)(14)(15) in our series, all patients received depth electrodes inserted longitudinally into each hippocampus (Fig. 1).…”

Section: Discussionmentioning

confidence: 99%

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Safety of Intrahippocampal Depth Electrodes for Presurgical Evaluation of Patients with Intractable Epilepsy

et al. 1997

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Summary:Purpose: Intracerebral depth electrodes are used in preoperative evaluation of selected patients with intractable epilepsies. In spite of their usefulness, safety of depth electrodes is disputed, and the number of insertions is decreasing. This study examined retrospectively possible deleterious effects such as perioperative complications, induction of epileptogenesis, and neuropsychologic deficits.Methods: Clinical course and neuroradiologic findings of 1 15 patients with bilaterally inserted longitudinal intrahippocampal depth electrodes (IDEs) were analyzed. Hippocampal resection specimens were examined histopathologically. To detect newly developed epileptogenic areas, EEG recordings, seizure control, and semiology after standardized resection procedures were compared between patients who received IDEs and those who did not. To demonstrate functional deficits caused by IDE insertion into an unaffected hippocampus of the speech-dominant hemisphere, changes of verbal learning and memory performances before and after right amygdalohippocampectomy were compared between patients evaluated with and without IDEs.Results: Five significant complications without any permanent neurologic deficit were noted, and only one was specifically linked to IDE insertion. The tissue damage associated with the insertion was minimal and sharply circumscribed. No differences of seizure outcome after standardized resections were identified between patients with and without IDEs. In postoperative EEG recordings, there was no evidence of new epileptogenic areas. No verbal memory deficit caused by IDE implantation into the hippocampus of the speech-dominant hemisphere was detectable.Conclusions: Results indicate that it is safe to implant these IDEs in selected patients. Key Words: Epilepsy surgerySafety-Depth electrodes-Memory-Hippocampus.Two thirds to three quarters of presurgical evaluation protocols use intracerebral depth electrodes (IDES) (1,2).The usefulness of depth electrodes has been well documented (3-10). Specifically, the aim of tailored resections with better neuropsychologic outcome demonstrates their increasing necessity (1 1,12). However, because of current budget cuts and the presumed risks, the number of depth-electrode insertions is decreasing. The main safety considerations are concerned with a higher rate of complications or with the possible induction of new epileptogenic zones. Furthermore, functional deficits may result from structural damage, especially if electrodes are inserted into a brain area that will not be resected (8,lO). All reports on safety profiles of depth electrodes have been limited to the assessment of neurologic complications and imaging findings (3,8,10,(13)(14)(15) in our series, all patients received depth electrodes inserted longitudinally into each hippocampus (Fig. 1).The hippocampus is one of the most vulnerable brain areas with respect to epileptogenesis, and its role in processing of declarative memory can be adequately measured by neuropsychological testing (1 l, 16-1 8). The...

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Section: No Impairment Of Verbal Memory and Learningsupporting

confidence: 83%

Section: Discussionmentioning

confidence: 99%

Safety of Intrahippocampal Depth Electrodes for Presurgical Evaluation of Patients with Intractable Epilepsy

et al. 1997

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“…Complications of subdural recording strips such as local hemorrhage or infection are treatable and occur at a low rate [108,109]. Implantation of the recording strip in patients with brain injury was justified since clinical assessment of patients with severe brain injury is often limited as patients are frequently stuporous or comatose.…”

Section: Tbi and Spontaneous Ichmentioning

confidence: 99%

Spreading Depolarization, A Pathophysiological Mechanism of Stroke and Migraine Aura

et al. 2011

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Spreading depolarization is a mechanism of abrupt, massive ion translocation between intraneuronal and extracellular space that entails cytotoxic edema in the brain’s gray matter. It is observed in patients as a large change of the slow electrical potential. Dependent on the energy status of the tissue, spreading depolarization is either preceded by nonspreading silencing due to neuronal hyperpolarization or accompanied by spreading silencing of electrical brain activity due to a depolarization block. Nonspreading silencing seems to translate into the initial clinical symptoms of ischemic stroke and spreading silencing translates into migraine aura. Direct electrophysiological evidence exists that spreading depolarization occurs in abundance in aneurysmal subarachnoid hemorrhage, delayed ischemic stroke after subarachnoid hemorrhage, malignant hemispheric stroke, spontaneous intracerebral hemorrhage and traumatic brain injury. Indirect evidence suggests its occurrence during migraine aura. In animals, spreading depolarizations facilitate neuronal death when they invade metabolically compromised tissue, whereas they are relatively innocuous in healthy tissue. Therapies targeting spreading depolarization may potentially treat these neurological conditions.

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“…The largest sample volume may be that of DC/AC-electrocorticography since spreading depolarizations invade the tissue surrounding the ischaemic zone and high recurrence rates may indicate even remotely developing ischaemic lesions OliveiraFerreira et al, 2010). However, even if reliable cut-off values are calculated for early diagnosis of delayed cerebral ischaemia after aneurismal SAH or ischaemic lesion progression after MHS, a slight risk for local infection or haemorrhage will remain with invasive probes (Espinosa et al, 1994;Lee et al, 2000). This obstacle will limit probe implantation to patients requiring neurosurgical interventions.…”

mentioning

confidence: 99%

Spreading Depressions as Secondary Insults after Traumatic Injury to the Human Brain

Hartings¹

2012

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Public reporting burden for this collection of information is estimated to average 1 hour per response, including the time for reviewing instructions, searching existing data sources, gathering and maintaining the data needed, and completing and reviewing this collection of information. Send comments regarding this burden estimate or any other aspect of this collection of information, including suggestions for reducing this burden to Department of Defense, Washington Headquarters Services, Directorate for Information Operations and Reports (0704-0188), 1215 Jefferson Davis Highway, Suite 1204, Arlington, VA 22202-4302. Respondents should be aware that notwithstanding any other provision of law, no person shall be subject to any penalty for failing to comply with a collection of information if it does not display a currently valid OMB control number. PLEASE DO NOT RETURN YOUR FORM TO THE ABOVE ADDRESS. REPORT DATE (DD-MM-YYYY)2. REPORT TYPE Annual DATES COVERED (From -To)1 Sept 11 -31 Aug 12 TITLE AND SUBTITLESpreading depressions as secondary insults after traumatic injury to the human brain 5a. CONTRACT NUMBER W81XWH-08-2-0016 injury to the human brain 5b. GRANT NUMBER W91ZSQ8005N668 5c. PROGRAM ELEMENT NUMBER AUTHOR(S)Jed A. Hartings, Ph.D.5d. PROJECT NUMBER 5e. TASK NUMBER 5f. WORK UNIT NUMBER PERFORMING ORGANIZATION NAME(S) AND ADDRESS(ES) AND ADDRESS(ES) PERFORMING ORGANIZATION REPORT NUMBERUniversity of Cincinnati Tana Housh University Hall Suite 530 PO Box 210222 Cincinnati, OH 45221-0222 SPONSORING / MONITORING AGENCY NAME(S) AND ADDRESS(ES) 10. SPONSOR/MONITOR'S ACRONYM(S) U.S. Army Medical Research and Materiel Command 1077 SPONSOR/MONITOR'S REPORT1077 Patchel St, Fort Detrick, MD 21702-5012 NUMBER(S) DISTRIBUTION / AVAILABILITY STATEMENTApproved for public release; distribution unlimited SUPPLEMENTARY NOTES ABSTRACTThis report describes year 4 progress of a multi-center study of neurosurgical TBI patients to determine the effects of spreading depression (SD), measured by electrocorticography, on neurologic outcome. In this year, we have enrolled 42 patients, bringing the study total to 136. Data collection, scoring, and monitoring has been completed for 90 patients. Using data from the present study combined with the pilot study, we published the finding that SD is independently associated with worse outcomes in 103 patients. These results establish SD as a mechanism of secondary injury. These analyses will be repeated with the full cohort from the present study and an advanced prognostic model will be developed based on more refined metrics of SD burden, secondary insults, and TBI pathoanatomy. Overall progress indicates that SD should be targeted therapeutically in a future interventional trial. We also found evidence that SD can be monitored non-invasively by scalp EEG recordings, thus providing a method to extend results to non-surgical TBI patients. SUBJECT TERMS I. INTRODUCTIONSevere TBI often results in delayed complications and deterioration of a patient's condition after initial stabilizati...

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Morbidity of Chronic Recording with Intracranial Depth Electrodes in 170 Patients

Cited by 36 publications

References 0 publications

Safety of Intrahippocampal Depth Electrodes for Presurgical Evaluation of Patients with Intractable Epilepsy

Safety of Intrahippocampal Depth Electrodes for Presurgical Evaluation of Patients with Intractable Epilepsy

Spreading Depolarization, A Pathophysiological Mechanism of Stroke and Migraine Aura

Spreading Depressions as Secondary Insults after Traumatic Injury to the Human Brain

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