Complications of invasive subdural grid monitoring in children with epilepsy

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Object. This study was performed to evaluate the complications of invasive subdural grid monitoring during epilepsy surgery in children.

Methods. The authors retrospectively reviewed the records of 35 consecutive children with intractable localization-related epilepsy who underwent invasive video electroencephalography (EEG) with subdural grid electrodes at The Hospital for Sick Children between 1996 and 2001. After subdural grid monitoring and identification of the epileptic regions, cortical excisions and/or multiple subpial transections (MSTs) were performed. Complications after these procedures were then categorized as either surgical or neurological.

There were 17 male and 18 female patients whose mean age was 11.7 years. The duration of epilepsy before surgery ranged from 2 to 17 years (mean 8.3 years). Fifteen children (43%) had previously undergone surgical procedures for epilepsy. The number of electrodes on the grids ranged from 40 to 117 (mean 95). During invasive video EEG, cerebrospinal fluid leaks occurred in seven patients. Also, cerebral edema (five patients), subdural hematoma (five patients), and intracerebral hematoma (three patients) were observed on postprocedural imaging studies but did not require surgical intervention. Hypertrophic scars on the scalp were observed in nine patients. There were three infections, including one case of osteomyelitis and two superficial wound infections. Blood loss and the amounts of subsequent transfusions correlated directly with the size and number of electrodes on the grids (p < 0.001). Twenty-eight children derived significant benefit from cortical resections and MSTs, with a more than 50% reduction of seizures and a mean follow-up period of 30 months.

Conclusions. The results of this study indicate that carefully selected pediatric patients with intractable epilepsy can benefit from subdural invasive monitoring procedures that entail definite but acceptable risks.

Article Information

Address reprint requests to: James T. Rutka, M.D., Ph.D., Division of Neurosurgery, Suite 1504, The Hospital for Sick Children, 555 University Avenue, Toronto, Ontario, Canada M5G 1X8. email: james.rutka@sickkids.ca.

© AANS, except where prohibited by US copyright law.

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Figures

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    Upper Left: Intraoperative photograph showing exposure of the hemisphere after craniotomy for subdural grid implantation. Most children underwent large craniotomies for implantation of subdural grids (the mean electrode number in the series was 95). Upper Right: Intraoperative photograph showing a large subdural grid with 105 electrodes. Two temporal depth and one subfrontal strip electrodes are also shown. Lower: Skull x-ray film showing positioning of the subdural grid, subdural strips, and depth electrodes.

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    Axial CT scan obtained after right cortical resection, demonstrating a small right frontal acute SDH for which no treatment was required.

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    Intraoperative photograph showing a linear SDH under the grid, which caused partial interference with electrophysiological recordings.

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    Axial CT scan obtained in a patient in whom a large right subdural grid and contralateral strip electrodes were implanted. Note the ICH in the right temporal lobe. The presumed mechanism of this hematoma was occlusion of venous outflow by the grid, which led to hemorrhagic infarction.

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