Stereoelectroencephalography in Pediatric Epilepsy Surgery

Tomlinson, Samuel B.; Buch, Vivek; Armstrong, Dallas; Kennedy, Benjamin C.

doi:10.3340/jkns.2019.0015

Cited by 16 publications

(15 citation statements)

References 97 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…7,10,32 SEEG can also monitor deep or medial structures directly and precisely, makes monitoring of multiple lobes or hemispheres more feasible, and avoids craniotomy altogether for patients who will undergo minimally invasive surgery or no surgery. 25,[33][34][35][36] As a result, the use of SEEG has become widespread in North American pediatric epilepsy centers over the past decade. 1,23,24 However, most centers avoid SEEG in the very young, especially those younger than age 2.…”

Section: Discussionmentioning

confidence: 99%

Stereoelectroencephalography before 2 years of age

Rahman

Tomlinson

Katz

et al. 2022

Neurosurgical Focus

Self Cite

View full text Add to dashboard Cite

OBJECTIVE Stereoelectroencephalography (SEEG) is a widely used technique for localizing seizure onset zones prior to resection. However, its use has traditionally been avoided in children under 2 years of age because of concerns regarding pin fixation in the immature skull, intraoperative and postoperative electrode bolt security, and stereotactic registration accuracy. In this retrospective study, the authors describe their experience using SEEG in patients younger than 2 years of age, with a focus on the procedure’s safety, feasibility, and accuracy as well as surgical outcomes. METHODS A retrospective review of children under 2 years of age who had undergone SEEG while at Children’s Hospital of Philadelphia between November 2017 and July 2021 was performed. Data on clinical characteristics, surgical procedure, imaging results, electrode accuracy measurements, and postoperative outcomes were examined. RESULTS Five patients younger than 2 years of age underwent SEEG during the study period (median age 20 months, range 17–23 months). The mean age at seizure onset was 9 months. Developmental delay was present in all patients, and epilepsy-associated genetic diagnoses included tuberous sclerosis (n = 1), KAT6B (n = 1), and NPRL3 (n = 1). Cortical lesions included tubers from tuberous sclerosis (n = 1), mesial temporal sclerosis (n = 1), and cortical dysplasia (n = 3). The mean number of placed electrodes was 11 (range 6–20 electrodes). Bilateral electrodes were placed in 1 patient. Seizure onset zones were identified in all cases. There were no SEEG-related complications, including skull fracture, electrode misplacement, hemorrhage, infection, cerebrospinal fluid leakage, electrode pullout, neurological deficit, or death. The mean target point error for all electrodes was 1.0 mm. All patients proceeded to resective surgery, with a mean follow-up of 21 months (range 8–53 months). All patients attained a favorable epilepsy outcome, including Engel class IA (n = 2), IC (n = 1), ID (n = 1), and IIA (n = 1). CONCLUSIONS SEEG can be safely, accurately, and effectively utilized in children under age 2 with good postoperative outcomes using standard SEEG equipment. With minimal modification, this procedure is feasible in those with immature skulls and guides the epilepsy team’s decision-making for early and optimal treatment of refractory epilepsy through effective localization of seizure onset zones.

show abstract

Section: Discussionmentioning

confidence: 99%

Stereoelectroencephalography before 2 years of age

Rahman

Tomlinson

Katz

et al. 2022

Neurosurgical Focus

Self Cite

View full text Add to dashboard Cite

show abstract

“…10 Well-established surgical options for pediatric MRE include resection, disconnection, neurostimulation, invasive monitoring via subdural grid (SDG) electrodes, or some combination thereof. 11 In many cases, resection is effective in disrupting the epileptogenic zone, controlling patient seizures, and improving quality of life. [11][12][13][14][15][16][17] However, open resections are invasive, associated with risks, and often unsuitable for patients with deep-seated foci.…”

Section: Clinical Articlementioning

confidence: 99%

Stereoelectroencephalography followed by combined electrode removal and MRI-guided laser interstitial thermal therapy or open resection: a single-center series in pediatric patients with medically refractory epilepsy

Slingerland¹,

Chua²,

Bolton

et al. 2023

Journal of Neurosurgery: Pediatrics

View full text Add to dashboard Cite

OBJECTIVE Stereoelectroencephalography (SEEG) and MRI-guided laser interstitial thermal therapy (MRgLITT) have emerged as safe, effective, and less invasive alternatives to subdural grid placement and open resection, respectively, for the localization and treatment of medically refractory epilepsy (MRE) in children. Reported pediatric experience combining these complementary techniques is limited, with traditional workflows separating electrode removal and ablation/resection. The authors describe the largest reported series of pediatric epilepsy patients who underwent MRgLITT following SEEG contrasted with a cohort that underwent craniotomy following SEEG, combining ablation/resection with electrode explantation as standard practice. METHODS The medical records of all patients with MRE who had undergone SEEG followed by MRgLITT or open resection/disconnection at Boston Children’s Hospital between November 2015 and December 2020 were retrospectively reviewed. Primary outcome variables included surgical complication rates, length of hospital stay following treatment, and Engel classification at the last follow-up. RESULTS Of 74 SEEG patients, 27 (median age 12.1 years, 63% female) underwent MRgLITT and 47 (median age 12.1 years, 49% female) underwent craniotomy. Seventy patients (95%) underwent SEEG followed by combined electrode removal and treatment. Eight MRgLITT cases (30%) and no open cases targeted the insula (p < 0.001). Complication rates did not differ, although trends toward more subdural/epidural hematomas, infarcts, and permanent unanticipated neurological deficits were evident following craniotomy, whereas a trend toward more temporary unanticipated neurological deficits was seen following MRgLITT. The median duration of hospitalization after treatment was 3 and 5 days for MRgLITT and open cases, respectively (p = 0.078). Seizure outcomes were similar between the cohorts, with 74% of MRgLITT and craniotomy patients attaining Engel class I or II outcomes (p = 0.386) at the last follow-up (median 1.1 and 1.9 years, respectively). CONCLUSIONS MRgLITT and open resection following SEEG can both effectively treat MRE in pediatric patients and generally can be performed in a two-surgery workflow during a single hospitalization. In appropriately selected patients, MRgLITT tended to be associated with shorter hospitalizations and fewer complications following treatment and may be best suited for focal deep-seated targets associated with relatively challenging open surgical approaches.

show abstract

“…Recent studies have shown that advances in imaging, planning, and robotic‐assisted surgery have made SEEG a safe tool in children, with low rates of adverse events such as hemorrhage and infection 3‐13 . Despite these advances, the rate of seizure‐free outcomes following SEEG‐guided resective surgery stands at 50%‐67% 4,9,13‐15 …”

Section: Introductionmentioning

confidence: 99%

The UK experience of stereoelectroencephalography in children: An analysis of factors predicting the identification of a seizure‐onset zone and subsequent seizure freedom

Chari¹,

Moeller²,

Boyd³

et al. 2021

Epilepsia

View full text Add to dashboard Cite

Objective Stereoelectroencephalography (SEEG) is being used more frequently in the pre‐surgical evaluation of children with focal epilepsy. It has been shown to be safe in children, but there are no multicenter studies assessing the rates and factors associated with the identification of a putative seizure‐onset zone (SOZ) and subsequent seizure freedom following SEEG‐guided epilepsy surgery. Methods Multicenter retrospective cohort study of all children undergoing SEEG at six of seven UK Children's Epilepsy Surgery Service centers from 2014 to 2019. Demographics, noninvasive evaluation, SEEG, and operative factors were analyzed to identify variables associated with the identification of a putative SOZ and subsequent seizure freedom following SEEG‐guided epilepsy surgery. Results One hundred thirty‐five patients underwent 139 SEEG explorations using a total of 1767 electrodes. A putative SOZ was identified in 117 patients (85.7%); odds of successfully finding an SOZ were 6.4 times greater for non‐motor seizures compared to motor seizures (p = 0.02) and 3.6 times more if four or more seizures were recorded during SEEG (p = 0.03). Of 100 patients undergoing surgical treatment, 47 (47.0%) had an Engel class I outcome at a median follow‐up of 1.3 years; the only factor associated with outcome was indication for SEEG (p = 0.03); an indication of “recurrence following surgery/treatment” had a 5.9 times lower odds of achieving seizure freedom (p = 0.002) compared to the “lesion negative” cohort, whereas other indications (“lesion positive, define extent,” “lesion positive, discordant noninvasive investigations” and “multiple lesions”) were not statistically significantly different. Significance This large nationally representative cohort illustrates that SEEG‐guided surgery can still achieve high rates of seizure freedom. Seizure semiology and the number of seizures recorded during SEEG are important factors in the identification of a putative SOZ, and the indication for SEEG is an important factor in postoperative outcomes.

show abstract

Stereoelectroencephalography in Pediatric Epilepsy Surgery

Cited by 16 publications

References 97 publications

Stereoelectroencephalography before 2 years of age

Stereoelectroencephalography before 2 years of age

Stereoelectroencephalography followed by combined electrode removal and MRI-guided laser interstitial thermal therapy or open resection: a single-center series in pediatric patients with medically refractory epilepsy

The UK experience of stereoelectroencephalography in children: An analysis of factors predicting the identification of a seizure‐onset zone and subsequent seizure freedom

Contact Info

Product

Resources

About