Variation in pediatric stereoelectroencephalography practice among pediatric neurosurgeons in the United States: survey results

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  • 1 Division of Pediatric Neurosurgery, Department of Neurosurgery, Children’s Hospital of Philadelphia;
  • | 2 Department of Neurosurgery, University of Pennsylvania, Philadelphia, Pennsylvania;
  • | 3 Rutgers-Robert Wood Johnson Medical School, New Brunswick, New Jersey; and
  • | 4 Division of Pediatric Neurosurgery, Department of Neurosurgery, Children’s of Alabama, University of Alabama at Birmingham, Alabama
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OBJECTIVE

Stereoelectroencephalography (SEEG) has become widespread in the United States during the past decade. Many pediatric neurosurgeons practicing SEEG may not have had experience with this technique during their formal training, and the literature is mostly limited to single-center series. As a result, implementation of this relatively new technique may vary at different institutions. The authors hypothesized that aspects of SEEG experience, techniques, and outcomes would vary widely among programs across the country.

METHODS

An electronic survey with 35 questions addressing the categories of training and experience, technique, electrode locations, and outcomes was sent to 128 pediatric epilepsy surgeons who were potential SEEG users.

RESULTS

Sixty-one pediatric fellowship-trained epilepsy surgeons in the United States responded to the survey. Eighty-nine percent were actively using SEEG in their practice. Seventy-two percent of SEEG programs were in existence for less than 5 years, and 68% were using SEEG for > 70% of their invasive monitoring. Surgeons at higher-volume centers operated on younger patients (p < 0.001). Most surgeons (70%) spent 1–3 hours per case planning electrode trajectories. Two-thirds of respondents reported a median implant duration of 5–7 days, but 16% reported never having an implant duration > 5 days, and 16% reported having had implants stay in place for > 4 weeks. The median response for the median number of electrodes initially implanted was 12 electrodes, although 19% of respondents reported median implants of 5–8 electrodes and 17% reported median implants of 15–18 electrodes. Having a higher volume of SEEG cases per year was associated with a higher median number of electrodes implanted (p < 0.001). Most surgeons found SEEG helpful in defining an epileptic network and reported that most of their SEEG patients undergo focal surgical treatment.

CONCLUSIONS

SEEG has been embraced by the pediatric epilepsy surgery community. Higher case volume is correlated with a tendency to place more electrodes and operate on younger patients. For most parameters addressed in the survey, responses from surgeons clustered around a norm, though additional findings of substantial variations highlight differences in implementation and philosophy among pediatric epilepsy programs.

ABBREVIATIONS

K-wire = Kirschner wire; MRE = medically refractory epilepsy; ROSA = robotic stereotactic assistance; SDG = subdural grid; SEEG = stereoelectroencephalography.

Supplementary Materials

    • Supplementary Appendix and Table 1 (PDF 223 KB)

Figure from Kelley et al. (pp 196–205).

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