The safety and efficacy of chronically implanted subdural electrodes: A prospective study

Be, Swartz; Rich, Justin; Dwan, P.S.; DeSalles, Antonio; Kaufman, Marshall; Walsh, Gregory O.; Delgado‐Escueta, Antonio V.

doi:10.1016/0090-3019(96)00083-3

Cited by 61 publications

(40 citation statements)

References 21 publications

Supporting

Mentioning

Contrasting

Unclassified

Order By: Relevance

“…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: 48%

Complications of Invasive Monitoring Used in Intractable Pediatric Epilepsy

2002

View full text Add to dashboard Cite

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.

show abstract

Section: Discussionsupporting

confidence: 48%

Complications of Invasive Monitoring Used in Intractable Pediatric Epilepsy

2002

View full text Add to dashboard Cite

show abstract

“…A major impetus for developing modern techniques of imaging nonstructural brain dysfunction in epilepsy is reduction of the need for or the extent of intracranial electrode implantation. Serious neurologic complications can occur in about 4-5% of depth electrode implantations (11) and up to 20% of subdural electrode implantations (12), although the risk for permanent neurologic deficits is usually less than 1%. A major drawback of intracranial recording is that it samples only a limited area of the brain.…”

Section: Ictal Eegmentioning

confidence: 99%

Integration of EEG, MRI, and SPECT in Localizing the Seizure Focus for Epilepsy Surgery

2000

Epilepsia

View full text Add to dashboard Cite

Summary: Several modalities are now available for detecting the structural and the functional abnormalities of a seizure focus. This article discusses the principles and techniques that can be used to integrate the data derived from different test modalities in delineating the seizure focus in epilepsy surgery candidates. An approach in integrating EEG, MRI, and SPECT abnormalities is described to demonstrate how the spatial relationships among them can be precisely determined by coregistering images of the abnormalities on the MRI. The recently developed technique of subtraction ictal SPECT coregistered to MRI (SISCOM) can reveal a discrete hyperperfusion focus with its relationship to the cerebral anatomy. The SISCOM focus can also serve as a target for intracranial electrode implantation and for subsequent surgical resection. This can be achieved by using a computer-based system of relating the image space to the surgical field. The limitations of each test in localizing the surgical seizure focus must be recognized when the value of each test is interpreted relative to those of other tests. In many patients, not all tests will show localizing abnormalities, and the foci determined by different tests may be incongruent. When the location of the focus is not compatible with the possible origin of the patient's habitual seizures, further evaluation with other tests, including intracranial EEG recordings, is necessary. The decision in determining which tests and how many to employ for localizing the surgical focus must be individualized for each patient. Key Words: EEG-MRI-SPECT-SISCOM-SeizurefociSurgical Planning.The success of focal epilepsy surgery strongly depends on accurate identification of the seizure focus. In their early pioneering work in epilepsy surgery, Sir Victor Horsley and Hughlings Jackson relied on their clinical observations and intraoperative examination to infer the location of the seizure focus for surgery (1). Since then, a number of technological advances have been made and have been used for identification of the potentially epileptogenic tissue for surgical resection. Modern technological modalities now utilized in localizing the surgical seizure focus include electrophysiology (EEG), cerebral structural imaging (MRI and magnetic resonance spectroscopy), cerebral function imaging (SPECT and PET), and magnetoencephalography (MEG). This article examines and discusses how EEG relates to the other modalities when used for evaluation of patients for focal epilepsy surgery. The technology of SPECT is used to demonstrate an approach of integrating the electrophysiologic, structural, and functional data derived from the presurgical evaluation of intractable epilepsy patients. ELECTROENCEPHALOGRAPHY Interictal EEGInterictal EEG is a safe and widely available tool for evaluating the extent and location of the seizure focus. With the advent of modern neuroimaging and of longterm video-EEG monitoring, interictal EEG recording remains an important localizing and prognostic tool in epilepsy surgery...

show abstract

“…Invasive electrophysiologic monitoring of patients with medically refractory epilepsy constitutes a common practice in the contemporary management of these patients [1][2][3][4]. The technique of subdural grid/strip electrode implantation, as it was introduced by Penfield and Jasper [5], has been widely employed in the invasive monitoring of epileptic patients, particularly when the localization of the primary focus cannot be provided by the ictal semiology, ictal and interictal surface EEG, neuropsychological testing, MRI and other functional neuroimaging studies [3].…”

Section: Introductionmentioning

confidence: 99%

“…The use of invasive monitoring has been associated, though, with infrequent but occasionally bothersome complications; the most frequent of them could be summarized to the following: infection [4,[8][9][10][11][12], postoperative subdural/epidural hematoma [12][13][14][15][16][17], significant headache [2,3], nausea [3], low-grade fever [2], cerebrospinal fluid leakage [18], temporalis muscle fibrosis [2], abscess formation [19], small cortical contusion [19,20], cerebrospinal fluid pleocytosis [14,21], increased intracranial pressure [14], elevated erythrocyte sedimentation rate [14] and meningovascular hypersensitivity-type reaction [21].…”

Section: Introductionmentioning

confidence: 99%

Nonhabitual Seizures in Patients with Implanted Subdural Electrodes

Fountas

King²,

Jenkins³

et al. 2004

Stereotact Funct Neurosurg

View full text Add to dashboard Cite

The implantation of subdural electrodes has been widely employed in the invasive monitoring of patients with medically refractory epilepsy. The use of subdural electrodes, though, has been associated with rare but occasionally troublesome complications. We report the occurrence of nonhabitual seizures after implanting subdural grid electrodes. Among 57 patients diagnosed with medically refractory epilepsy who were evaluated in our department over a 12-month period, 21 patients underwent craniotomy for subdural grid/strip electrode implantation. Subdural grids and strips (AdTech, Racine, Wisc., USA) were used for continuous video EEG monitoring. In 3 patients, during subdural monitoring, consistent nonhabitual seizure activity was recorded. This was both clinically and electrographically different than the patients’ habitual seizures. The patients’ nonhabitual seizures disappeared postoperatively after removing the implanted electrodes. The occurrence of nonhabitual seizures, though quite rare, could lead to mislocalization of an epileptogenic focus. This complication might be the result of direct mechanical cortical irritation or chemical irritation caused by blood breakdown products. The occurrence of nonhabitual seizures comes to add itself to the existing list of complications associated with employment of subdural electrodes for invasive monitoring.

show abstract

The safety and efficacy of chronically implanted subdural electrodes: A prospective study

Cited by 61 publications

References 21 publications

Complications of Invasive Monitoring Used in Intractable Pediatric Epilepsy

Complications of Invasive Monitoring Used in Intractable Pediatric Epilepsy

Integration of EEG, MRI, and SPECT in Localizing the Seizure Focus for Epilepsy Surgery

Nonhabitual Seizures in Patients with Implanted Subdural Electrodes

Contact Info

Product

Resources

About