Subdural interhemispheric grid electrodes for intracranial epilepsy monitoring: feasibility, safety, and utility

Bekelis, Kimon; Radwan, Tarek; Desai, Atman; Moses, Ziev B.; Thadani, Vijay M.; Jobst, Barbara C.; Bujarski, Krzysztof A.; Darcey, Terrance M.; Roberts, David W.

doi:10.3171/2012.8.jns12258

Cited by 25 publications

(29 citation statements)

References 33 publications

(41 reference statements)

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“…48 MRI-generated gyral maps revealing venous/sulcal landmarks and intraoperative neuronavigation facilitate the implantation. Although the location and size of the craniotomy are important for achieving the desired electrode coverage, it should also take the anticipated resection into consideration.…”

Section: Techniquementioning

confidence: 99%

“…Both the subdural and depth electrodes can be used as strategic guides during resection. 48 Furthermore, subdural electrode placement is usually challenging in patients who have undergone prior surgery because the dura is often adherent and difficult to peel. 50,51 It must be remembered, however, that subdural electrodes may miss activity from deep epileptogenic sources or closed fields, a limitation overcome by concomitant use of intracerebral depth electrodes placed in select deep targets.…”

Section: Strengths and Limitationsmentioning

confidence: 99%

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Diagnostic utility of invasiveEEGfor epilepsy surgery: Indications, modalities, and techniques

et al. 2016

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Many patients with medically refractory epilepsy now undergo successful surgery based on noninvasive diagnostic information, but intracranial electroencephalography (IEEG) continues to be used as increasingly complex cases are considered surgical candidates. The indications for IEEG and the modalities employed vary across epilepsy surgical centers; each modality has its advantages and limitations. IEEG can be performed in the same intraoperative setting, that is, intraoperative electrocorticography, or through an independent implantation procedure with chronic extraoperative recordings; the latter are not only resource intensive but also carry risk. A lack of understanding of IEEG limitations predisposes to data misinterpretation that can lead to denying surgery when indicated or, worse yet, incorrect resection with adverse outcomes. Given the lack of class 1 or 2 evidence on IEEG, a consensus-based expert recommendation on the diagnostic utility of IEEG is presented, with emphasis on the application of various modalities in specific substrates or locations, taking into account their relative efficacy, safety, ease, and incremental cost-benefit. These recommendations aim to curtail outlying indications that risk the over- or underutilization of IEEG, while retaining substantial flexibility in keeping with most standard practices at epilepsy centers and addressing some of the needs of resource-poor regions around the world.

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Section: Techniquementioning

confidence: 99%

Section: Strengths and Limitationsmentioning

confidence: 99%

Diagnostic utility of invasiveEEGfor epilepsy surgery: Indications, modalities, and techniques

et al. 2016

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“…Among the SEEG patients, the etiology was identified as a temporal epileptogenic focus in 42.2% of patients, 15,22,23,[26][27][28][29] tumor in 6.7% of patients, 22,23,27,28,30 FCD1 in 39.2% of patients, 16,23,27,28,[31][32][33] FCD2 in 10.7% of patients, 23,28,31 and lesional in 41.5% of patients. [15][16][17]22,23,[28][29][30][31]34 Among the SDE patients, the etiology was identified as a temporal epileptogenic focus in 40.9% of patients, 18,21,25,[35][36][37][38][39][40][41][42][43][44][45] tumor in 16.0% of patients, 18,20,21,…”

Section: Cohort Descriptionmentioning

confidence: 99%

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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“…A few studies have evaluated the usefulness and safety versus the risks associated with implantation of intracranial electrodes, and the benefits of invasive workup for epilepsy surgery in general seem to outweigh the risks 11 12…”

Section: Introductionmentioning

confidence: 99%

Complications to invasive epilepsy surgery workup with subdural and depth electrodes: a prospective population-based observational study

Hedegärd

Bjellvi

Edelvik

et al. 2013

Journal of Neurology, Neurosurgery & Psychiatry

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ObjectiveIn some patients who undergo presurgical workup for drug-resistant epilepsy invasive seizure monitoring is needed to define the seizure onset zone and delineate eloquent cortex. Such procedures carry risks for complications causing permanent morbidity and even mortality. In this study, prospective data on complications in a national population-based sample were analysed.DesignComplication data from the prospective Swedish National Epilepsy Surgery Register were analysed for 271 patients in whom therapeutic surgery was preceded by invasive monitoring 1996–2010.ResultsComplications occurred in 13/271 patients (4.8%). Subdural grids carried the highest risk of complications (7.4%). There was no surgical mortality or permanent morbidity. Subdural haematomas were most common (n=7) followed by epidural haematomas (n=3). Valproate treatment and having a haematoma was associated with an OR of 1.53 (CI 0.38 to 6.12) compared to having a haematoma without valproate treatment. Having a complication during invasive monitoring was associated with a significant OR of 6.27 (CI 1.32 to 29.9) of also having a complication at therapeutic surgery compared to the risk of having a complication only at surgery.ConclusionsIn this prospective population-based epilepsy surgery series, the most common complications were haematomas, and subdural grids carried the highest risk. Close supervision and rapid interventions led to avoidance of permanent morbidity. The clinical implications of the slightly increased risk of haematomas with valproate treatment needs further investigation as does the finding of an increased risk for complications at epilepsy surgery for patients who had a complication during invasive monitoring.

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Subdural interhemispheric grid electrodes for intracranial epilepsy monitoring: feasibility, safety, and utility

Abstract: The use of IHGEs in intracranial epilepsy monitoring has a favorable risk profile and in the authors' experience proved to be a valuable component of intracranial investigation, providing the sole evidence for resection of some epileptogenic foci.

Cited by 25 publications

References 33 publications

Diagnostic utility of invasiveEEGfor epilepsy surgery: Indications, modalities, and techniques

Diagnostic utility of invasiveEEGfor epilepsy surgery: Indications, modalities, and techniques

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

Complications to invasive epilepsy surgery workup with subdural and depth electrodes: a prospective population-based observational study

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