Optimizations and Nuances in Neurosurgical Technique for the Minimization of Complications in Subdural Electrode Placement for Epilepsy Surgery

Background Surgical intervention is an important therapeutic option for patients with intractable epilepsy and a well-characterized epileptogenic focus. Invasive monitoring with subdural electrodes is an effective technique for localizing epileptogenic foci. Previous studies reported varying complic...

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Veröffentlicht in:World neurosurgery 2015-10, Vol.84 (4), p.989-997
Hauptverfasser: Falowski, Steven M, DiLorenzo, Daniel J, Shannon, Larry R, Wallace, David J, Devries, James, Kellogg, Robert G, Cozzi, Nicholas P, Fogg, Lou F, Byrne, Richard W
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container_end_page 997
container_issue 4
container_start_page 989
container_title World neurosurgery
container_volume 84
creator Falowski, Steven M
DiLorenzo, Daniel J
Shannon, Larry R
Wallace, David J
Devries, James
Kellogg, Robert G
Cozzi, Nicholas P
Fogg, Lou F
Byrne, Richard W
description Background Surgical intervention is an important therapeutic option for patients with intractable epilepsy and a well-characterized epileptogenic focus. Invasive monitoring with subdural electrodes is an effective technique for localizing epileptogenic foci. Previous studies reported varying complication rates, and these may deter more widespread adoption. We present potentially valuable technical nuances that may be associated with low complication rates. We assess the potential contribution of specific aspects of surgical technique to the reduction of complication rates. Methods We retrospectively reviewed patients from the Rush University Surgical Epilepsy database who underwent craniotomies for invasive electroencephalography monitoring for medically intractable epilepsy using our technique. We analyzed and compared complication rates and techniques with those reported elsewhere. Results The sample group comprised 127 consecutive patients who underwent electrode implantation. The average monitoring period was 6 days. There were 5 complications (3.9%), including 1 subdural hematoma requiring surgery (0.8%), 1 infection (0.8%), 2 pulmonary emboli (1.6%), and 1 deep vein thrombosis (0.8%). There were no symptomatic cerebrospinal fluid leaks or permanent neurologic complications. These results compare favorably with published results. Analysis and comparison of our technique anecdotally suggest the importance of use of a subgaleal drain throughout the monitoring period, postoperative antibiotic coverage for 1 week, meticulous hemostasis, and secure suturing of the electrodes to the dura mater to minimize trauma to superficial vessels as potential contributors to improved complication rates. Conclusions A very low incidence of major morbidity can be achieved in invasive electroencephalography monitoring with this protocol.
doi_str_mv 10.1016/j.wneu.2015.01.018
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Invasive monitoring with subdural electrodes is an effective technique for localizing epileptogenic foci. Previous studies reported varying complication rates, and these may deter more widespread adoption. We present potentially valuable technical nuances that may be associated with low complication rates. We assess the potential contribution of specific aspects of surgical technique to the reduction of complication rates. Methods We retrospectively reviewed patients from the Rush University Surgical Epilepsy database who underwent craniotomies for invasive electroencephalography monitoring for medically intractable epilepsy using our technique. We analyzed and compared complication rates and techniques with those reported elsewhere. Results The sample group comprised 127 consecutive patients who underwent electrode implantation. The average monitoring period was 6 days. There were 5 complications (3.9%), including 1 subdural hematoma requiring surgery (0.8%), 1 infection (0.8%), 2 pulmonary emboli (1.6%), and 1 deep vein thrombosis (0.8%). There were no symptomatic cerebrospinal fluid leaks or permanent neurologic complications. These results compare favorably with published results. Analysis and comparison of our technique anecdotally suggest the importance of use of a subgaleal drain throughout the monitoring period, postoperative antibiotic coverage for 1 week, meticulous hemostasis, and secure suturing of the electrodes to the dura mater to minimize trauma to superficial vessels as potential contributors to improved complication rates. Conclusions A very low incidence of major morbidity can be achieved in invasive electroencephalography monitoring with this protocol.</description><identifier>ISSN: 1878-8750</identifier><identifier>EISSN: 1878-8769</identifier><identifier>DOI: 10.1016/j.wneu.2015.01.018</identifier><identifier>PMID: 25681595</identifier><language>eng</language><publisher>United States: Elsevier Inc</publisher><subject>Adolescent ; Adult ; Child ; Child, Preschool ; Complications ; Craniotomy ; Depth electrode ; Drainage ; Electrodes ; Electrodes, Implanted - adverse effects ; Electroencephalography ; Epilepsy ; Epilepsy - surgery ; Female ; Humans ; Implanted electrodes ; Intracranial EEG ; Intracranial Pressure ; Intraoperative Neurophysiological Monitoring ; Invasive EEG ; Male ; Middle Aged ; Neurosurgery ; Neurosurgical Procedures - adverse effects ; Neurosurgical Procedures - methods ; Postoperative Complications - epidemiology ; Postoperative Complications - prevention &amp; control ; Postoperative Hemorrhage - epidemiology ; Retrospective Studies ; Subdural electrodes ; Subdural Space - surgery ; Surgical closure technique ; Surgical Wound Infection - epidemiology ; Young Adult</subject><ispartof>World neurosurgery, 2015-10, Vol.84 (4), p.989-997</ispartof><rights>2015</rights><rights>Copyright © 2015. 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Invasive monitoring with subdural electrodes is an effective technique for localizing epileptogenic foci. Previous studies reported varying complication rates, and these may deter more widespread adoption. We present potentially valuable technical nuances that may be associated with low complication rates. We assess the potential contribution of specific aspects of surgical technique to the reduction of complication rates. Methods We retrospectively reviewed patients from the Rush University Surgical Epilepsy database who underwent craniotomies for invasive electroencephalography monitoring for medically intractable epilepsy using our technique. We analyzed and compared complication rates and techniques with those reported elsewhere. Results The sample group comprised 127 consecutive patients who underwent electrode implantation. The average monitoring period was 6 days. There were 5 complications (3.9%), including 1 subdural hematoma requiring surgery (0.8%), 1 infection (0.8%), 2 pulmonary emboli (1.6%), and 1 deep vein thrombosis (0.8%). There were no symptomatic cerebrospinal fluid leaks or permanent neurologic complications. These results compare favorably with published results. Analysis and comparison of our technique anecdotally suggest the importance of use of a subgaleal drain throughout the monitoring period, postoperative antibiotic coverage for 1 week, meticulous hemostasis, and secure suturing of the electrodes to the dura mater to minimize trauma to superficial vessels as potential contributors to improved complication rates. 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control</subject><subject>Postoperative Hemorrhage - epidemiology</subject><subject>Retrospective Studies</subject><subject>Subdural electrodes</subject><subject>Subdural Space - surgery</subject><subject>Surgical closure technique</subject><subject>Surgical Wound Infection - epidemiology</subject><subject>Young Adult</subject><issn>1878-8750</issn><issn>1878-8769</issn><fulltext>true</fulltext><rsrctype>article</rsrctype><creationdate>2015</creationdate><recordtype>article</recordtype><sourceid>EIF</sourceid><recordid>eNp9Uk1v1DAUtBCIVqV_gAPykcsufkmcOBJCQqvlQyotUsvZcuyX1ktiBzsGbf9E_zIOW_bAAetJfoeZkd7MEPIS2BoY1G92618O07pgwNcM8ogn5BREI1aiqdunx52zE3Ie447lV0IlmvI5OSl4LYC3_JQ8XE2zHe29mq13kSpn6GVSTmOk1tFLTMHHFG6tVgO9QX3n7I-EtPeBzndIv1h3JFPf040fpyFjD2JZ4Dp1JoXM3Q6o5-AN0q-D0jiim_-obCc74BT3GRluMexfkGe9GiKeP_5n5NuH7c3m0-ri6uPnzfuLla4A5hVHwXrdNYY1YErVGkRRQctaBaJjiJxxUSjTq6ruC1NVRnVQ6Ub0na5RG16ekdcH3Sn4fFGc5WijxmFQDn2KEpoCypqVRZuhxQGqsxcxYC-nYEcV9hKYXLKQO7lkIZcsJIM8IpNePeqnbkRzpPx1PgPeHgCYr_xpMcioLWbjjQ3ZKmm8_b_-u3_oeshh5Ji-4x7jzqfgsn8SZCwkk9dLG5YyAM89qFhd_gaM_rOn</recordid><startdate>20151001</startdate><enddate>20151001</enddate><creator>Falowski, Steven M</creator><creator>DiLorenzo, Daniel J</creator><creator>Shannon, Larry R</creator><creator>Wallace, David J</creator><creator>Devries, James</creator><creator>Kellogg, Robert G</creator><creator>Cozzi, Nicholas P</creator><creator>Fogg, Lou F</creator><creator>Byrne, Richard W</creator><general>Elsevier Inc</general><scope>CGR</scope><scope>CUY</scope><scope>CVF</scope><scope>ECM</scope><scope>EIF</scope><scope>NPM</scope><scope>AAYXX</scope><scope>CITATION</scope><scope>7X8</scope></search><sort><creationdate>20151001</creationdate><title>Optimizations and Nuances in Neurosurgical Technique for the Minimization of Complications in Subdural Electrode Placement for Epilepsy Surgery</title><author>Falowski, Steven M ; 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control</topic><topic>Postoperative Hemorrhage - epidemiology</topic><topic>Retrospective Studies</topic><topic>Subdural electrodes</topic><topic>Subdural Space - surgery</topic><topic>Surgical closure technique</topic><topic>Surgical Wound Infection - epidemiology</topic><topic>Young Adult</topic><toplevel>peer_reviewed</toplevel><toplevel>online_resources</toplevel><creatorcontrib>Falowski, Steven M</creatorcontrib><creatorcontrib>DiLorenzo, Daniel J</creatorcontrib><creatorcontrib>Shannon, Larry R</creatorcontrib><creatorcontrib>Wallace, David J</creatorcontrib><creatorcontrib>Devries, James</creatorcontrib><creatorcontrib>Kellogg, Robert G</creatorcontrib><creatorcontrib>Cozzi, Nicholas P</creatorcontrib><creatorcontrib>Fogg, Lou F</creatorcontrib><creatorcontrib>Byrne, Richard W</creatorcontrib><collection>Medline</collection><collection>MEDLINE</collection><collection>MEDLINE (Ovid)</collection><collection>MEDLINE</collection><collection>MEDLINE</collection><collection>PubMed</collection><collection>CrossRef</collection><collection>MEDLINE - Academic</collection><jtitle>World neurosurgery</jtitle></facets><delivery><delcategory>Remote Search Resource</delcategory><fulltext>fulltext</fulltext></delivery><addata><au>Falowski, Steven M</au><au>DiLorenzo, Daniel J</au><au>Shannon, Larry R</au><au>Wallace, David J</au><au>Devries, James</au><au>Kellogg, Robert G</au><au>Cozzi, Nicholas P</au><au>Fogg, Lou F</au><au>Byrne, Richard W</au><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>Optimizations and Nuances in Neurosurgical Technique for the Minimization of Complications in Subdural Electrode Placement for Epilepsy Surgery</atitle><jtitle>World neurosurgery</jtitle><addtitle>World Neurosurg</addtitle><date>2015-10-01</date><risdate>2015</risdate><volume>84</volume><issue>4</issue><spage>989</spage><epage>997</epage><pages>989-997</pages><issn>1878-8750</issn><eissn>1878-8769</eissn><abstract>Background Surgical intervention is an important therapeutic option for patients with intractable epilepsy and a well-characterized epileptogenic focus. Invasive monitoring with subdural electrodes is an effective technique for localizing epileptogenic foci. Previous studies reported varying complication rates, and these may deter more widespread adoption. We present potentially valuable technical nuances that may be associated with low complication rates. We assess the potential contribution of specific aspects of surgical technique to the reduction of complication rates. Methods We retrospectively reviewed patients from the Rush University Surgical Epilepsy database who underwent craniotomies for invasive electroencephalography monitoring for medically intractable epilepsy using our technique. We analyzed and compared complication rates and techniques with those reported elsewhere. Results The sample group comprised 127 consecutive patients who underwent electrode implantation. The average monitoring period was 6 days. There were 5 complications (3.9%), including 1 subdural hematoma requiring surgery (0.8%), 1 infection (0.8%), 2 pulmonary emboli (1.6%), and 1 deep vein thrombosis (0.8%). There were no symptomatic cerebrospinal fluid leaks or permanent neurologic complications. These results compare favorably with published results. Analysis and comparison of our technique anecdotally suggest the importance of use of a subgaleal drain throughout the monitoring period, postoperative antibiotic coverage for 1 week, meticulous hemostasis, and secure suturing of the electrodes to the dura mater to minimize trauma to superficial vessels as potential contributors to improved complication rates. Conclusions A very low incidence of major morbidity can be achieved in invasive electroencephalography monitoring with this protocol.</abstract><cop>United States</cop><pub>Elsevier Inc</pub><pmid>25681595</pmid><doi>10.1016/j.wneu.2015.01.018</doi><tpages>9</tpages></addata></record>
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subjects Adolescent
Adult
Child
Child, Preschool
Complications
Craniotomy
Depth electrode
Drainage
Electrodes
Electrodes, Implanted - adverse effects
Electroencephalography
Epilepsy
Epilepsy - surgery
Female
Humans
Implanted electrodes
Intracranial EEG
Intracranial Pressure
Intraoperative Neurophysiological Monitoring
Invasive EEG
Male
Middle Aged
Neurosurgery
Neurosurgical Procedures - adverse effects
Neurosurgical Procedures - methods
Postoperative Complications - epidemiology
Postoperative Complications - prevention & control
Postoperative Hemorrhage - epidemiology
Retrospective Studies
Subdural electrodes
Subdural Space - surgery
Surgical closure technique
Surgical Wound Infection - epidemiology
Young Adult
title Optimizations and Nuances in Neurosurgical Technique for the Minimization of Complications in Subdural Electrode Placement for Epilepsy Surgery
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