Delayed intracranial hematoma following stereoelectroencephalography for intractable epilepsy

Case report

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Intracranial bleeding following stereoelectroencephalography (sEEG) is rare and commonly occurs early after electrode implantation. The authors report the case of a delayed intracranial hematoma following sEEG. This 10-year-old boy was referred to the authors' department to undergo an sEEG study for intractable epilepsy, with the hypothesis of a single localized epileptic zone in the left precentral region. To perform the exploration, 14 depth electrodes were implanted under stereotactic conditions. The results of a postoperative CT scan performed routinely at the end of the surgical procedure were normal. Eight days later, following an epileptic seizure, the child's condition worsened. The neurological examination revealed a left hemiparesis, agitation, and coma due to a right subdural hematoma with intraparenchymal bleeding. Despite a surgical evacuation followed by a decompressive craniectomy, the curative treatments were stopped 1 week later due to severe diffuse ischemic lesions found on MRI studies.

This is the first observation of a delayed hematoma following an sEEG procedure. The mechanism underlying this complication remains unclear, but the rupture of a growing pseudoaneurysm caused by the electrode's implantation or the tearing of a neighboring vessel by an electrode were suspected. In consequence, physicians must remain vigilant during the entire sEEG recording period and probably also several days after electrode removal.

Abbreviations used in this paper:ICH = intracranial hematoma; SDH = subdural hematoma; sEEG = stereoelectroencephalography.
Article Information

Contributor Notes

Address correspondence to: Stéphane Derrey, M.D., Department of Neurosurgery, Rouen University Hospital, 1 rue de Germont, 76031 Rouen, France. email: stephane.derrey@chu-rouen.fr.Please include this information when citing this paper: published online September 28, 2012; DOI: 10.3171/.2012.8.PEDS12114

© Copyright 1944-2019 American Association of Neurological Surgeons

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References
  • 1

    Behrens ESchramm JZentner JKönig R: Surgical and neurological complications in a series of 708 epilepsy surgery procedures. Neurosurgery 41:1101997

    • Search Google Scholar
    • Export Citation
  • 2

    Blatt DRRoper SNFriedman WA: Invasive monitoring of limbic epilepsy using stereotactic depth and subdural strip electrodes: surgical technique. Surg Neurol 48:74791997

    • Search Google Scholar
    • Export Citation
  • 3

    Burneo JGSteven DAMcLachlan RSParrent AG: Morbidity associated with the use of intracranial electrodes for epilepsy surgery. Can J Neurol Sci 33:2232272006

    • Search Google Scholar
    • Export Citation
  • 4

    Cahan LDCrandall PHNeurosurgical aspects of epilepsy in children and adolescents. Youmans JR: Neurological Surgery PhiladelphiaSaunders1990. 42714287

    • Search Google Scholar
    • Export Citation
  • 5

    Chen DConcus APHalbach VVCheung SW: Epistaxis originating from traumatic pseudoaneurysm of the internal carotid artery: diagnosis and endovascular therapy. Laryngoscope 108:3263311998

    • Search Google Scholar
    • Export Citation
  • 6

    Cossu MCardinale FCastana LCitterio AFrancione STassi L: Stereoelectroencephalography in the presurgical evaluation of focal epilepsy: a retrospective analysis of 215 procedures. Neurosurgery 57:7067182005

    • Search Google Scholar
    • Export Citation
  • 7

    Dario ADorizzi AScamoni CCerati MBalcone Grimaldi G: Iatrogenic intracranial aneurysm. Case report and review of the literature. J Neurosurg Sci 41:1952021997

    • Search Google Scholar
    • Export Citation
  • 8

    Dawkins AAEvans ALWattam JRomanowski CAConnolly DJHodgson TJ: Complications of cerebral angiography: a prospective analysis of 2,924 consecutive procedures. Neuroradiology 49:7537592007

    • Search Google Scholar
    • Export Citation
  • 9

    De Almeida ANOlivier AQuesney FDubeau FSavard GAndermann F: Efficacy of and morbidity associated with stereoelectroencephalography using computerized tomography— or magnetic resonance imaging-guided electrode implantation. J Neurosurg 104:4834872006

    • Search Google Scholar
    • Export Citation
  • 10

    Engel J JrCrandall PHRausch RThe partial epilepsies. Rosenberg RNGrossman RGSchoceht S: The Clinical Neurosciences New YorkChurchill Livingstone1983. 2:13491380

    • Search Google Scholar
    • Export Citation
  • 11

    Guenot MIsnard JRyvlin PFischer COstrowsky KMauguiere F: Neurophysiological monitoring for epilepsy surgery: the Talairach SEEG method. StereoElectroEncephaloGraphy Indications, results, complications and therapeutic applications in a series of 100 consecutive cases. Stereotact Funct Neurosurg 77:29322001

    • Search Google Scholar
    • Export Citation
  • 12

    Lee WSLee JKLee SAKang JKKo TS: Complications and results of subdural grid electrode implantation in epilepsy surgery. Surg Neurol 54:3463512000

    • Search Google Scholar
    • Export Citation
  • 13

    Munari CDepth electrode implantation at Höpital Sainte Anne, Paris. Engel JJ: Surgical Treatment of the Epilepsies New YorkRaven Press1987. 583588

    • Search Google Scholar
    • Export Citation
  • 14

    Pilcher WHRusyniak WG: Complications of epilepsy surgery. Neurosurg Clin N Am 4:3113251993

  • 15

    Rosenbaum TJLaxer KDVessely MSmith WB: Subdural electrodes for seizure focus localization. Neurosurgery 19:73811986

  • 16

    Ross DABrunberg JADrury IHenry TR: Intracerebral depth electrode monitoring in partial epilepsy: the morbidity and efficacy of placement using magnetic resonance imageguided stereotactic surgery. Neurosurgery 39:3273341996

    • Search Google Scholar
    • Export Citation
  • 17

    Rydenhag BSilander HC: Complications of epilepsy surgery after 654 procedures in Sweden, September 1990–1995: a multicenter study based on the Swedish National Epilepsy Surgery Register. Neurosurgery 49:51572001

    • Search Google Scholar
    • Export Citation
  • 18

    Sansur CAFrysinger RCPouratian NFu KMBittl MOskouian RJ: Incidence of symptomatic hemorrhage after stereotactic electrode placement. J Neurosurg 107:99810032007

    • Search Google Scholar
    • Export Citation
  • 19

    Talairach JBancaud JSzikla GBonis AGeier SVedrenne C: [New approach to the neurosurgery of epilepsy. Stereotaxic methodology and therapeutic results. 1. Introduction and history.]. Neurochirurgie 20:Suppl 112401974. (Fr)

    • Search Google Scholar
    • Export Citation
  • 20

    Tanriverdi TAjlan APoulin NOlivier A: Morbidity in epilepsy surgery: an experience based on 2449 epilepsy surgery procedures from a single institution. Clinical article. J Neurosurg 110:111111232009

    • Search Google Scholar
    • Export Citation
  • 21

    Van Buren JMComplications of surgical procedures in the diagnosis and treatment of epilepsy. Engel JJ: Surgical Treatment of the Epilepsies New YorkRaven Press1987. 465475

    • Search Google Scholar
    • Export Citation
  • 22

    Van Roost DSolymosi LSchramm Jvan Oosterwyck BElger CE: Depth electrode implantation in the length axis of the hippocampus for the presurgical evaluation of medial temporal lobe epilepsy: a computed tomography-based stereotactic insertion technique and its accuracy. Neurosurgery 43:8198271998

    • Search Google Scholar
    • Export Citation
  • 23

    Zesiewicz TASullivan KLHoffmann MBenes LMSmith DAWard CL: Delayed thalamic intracranial hemorrhage in an essential tremor patient following deep brain stimulation. Eur Neurol 59:1871892008

    • Search Google Scholar
    • Export Citation
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