Intracranial electroencephalography with subdural grid electrodes: Techniques, complications, and outcomes

Jamie Van Gompel, Gregory Alan Worrell, Michael L. Bell, Todd A. Patrick, Gregory D Cascino, Corey Raffel, W. Richard Marsh, Fredric B. Meyer

Research output: Contribution to journalArticle

103 Citations (Scopus)

Abstract

Objective: Intracranial subdural grid monitoring is a useful diagnostic technique for surgical localization in patients with intractable partial epilepsy. The rationale for the present study was to assess the morbidity of intracranial recordings and the surgical outcomes. Methods: We retrospectively reviewed the clinical data for 189 unique patients undergoing 198 intracranial subdural grid monitoring sessions between 1996 and 2004 at a tertiary epilepsy center. Results: The mean age of patients undergoing monitoring was 28 ± 14 years. An average of 63 ± 23 electrodes were inserted. The mean duration of monitoring was 8 ± 4 days. Localization of an epileptogenic zone occurred in 156 sessions (79%) resulting in 136 resections (69%). There were 13 major complications (6.6%), including five infections and six hematomas. Three patients (1.5%) developed permanent deficits related to implantation. Sixty-two (47%) of 136 patients undergoing resection were seizure-free after resection. An additional 38 patients (28%) had a significant reduction in seizures. The mean follow-up was 51 ± 30 months. The duration of monitoring, bone flap replacement, number of electrodes, and perioperative corticosteroids were not associated with infection or complication. Conclusion: Subdural grid monitoring for identification an epileptogenic focus is high yield, revealing a focus in 79% of monitoring sessions. Complications rarely result in permanent morbidity (1.5%). Surgical outcome indicated that 74% of patients experienced a favorable reduction in seizure tendency.

Original languageEnglish (US)
Pages (from-to)498-505
Number of pages8
JournalNeurosurgery
Volume63
Issue number3
DOIs
StatePublished - Sep 2008

Fingerprint

Electrodes
Seizures
Surgical Diagnostic Techniques
Morbidity
Partial Epilepsy
Physiologic Monitoring
Infection
Hematoma
Electrocorticography
Epilepsy
Adrenal Cortex Hormones
Bone and Bones

Keywords

  • Epilepsy
  • Invasive electroencephalography
  • Subdural grid

ASJC Scopus subject areas

  • Clinical Neurology
  • Surgery

Cite this

Intracranial electroencephalography with subdural grid electrodes : Techniques, complications, and outcomes. / Van Gompel, Jamie; Worrell, Gregory Alan; Bell, Michael L.; Patrick, Todd A.; Cascino, Gregory D; Raffel, Corey; Marsh, W. Richard; Meyer, Fredric B.

In: Neurosurgery, Vol. 63, No. 3, 09.2008, p. 498-505.

Research output: Contribution to journalArticle

Van Gompel, Jamie ; Worrell, Gregory Alan ; Bell, Michael L. ; Patrick, Todd A. ; Cascino, Gregory D ; Raffel, Corey ; Marsh, W. Richard ; Meyer, Fredric B. / Intracranial electroencephalography with subdural grid electrodes : Techniques, complications, and outcomes. In: Neurosurgery. 2008 ; Vol. 63, No. 3. pp. 498-505.
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abstract = "Objective: Intracranial subdural grid monitoring is a useful diagnostic technique for surgical localization in patients with intractable partial epilepsy. The rationale for the present study was to assess the morbidity of intracranial recordings and the surgical outcomes. Methods: We retrospectively reviewed the clinical data for 189 unique patients undergoing 198 intracranial subdural grid monitoring sessions between 1996 and 2004 at a tertiary epilepsy center. Results: The mean age of patients undergoing monitoring was 28 ± 14 years. An average of 63 ± 23 electrodes were inserted. The mean duration of monitoring was 8 ± 4 days. Localization of an epileptogenic zone occurred in 156 sessions (79{\%}) resulting in 136 resections (69{\%}). There were 13 major complications (6.6{\%}), including five infections and six hematomas. Three patients (1.5{\%}) developed permanent deficits related to implantation. Sixty-two (47{\%}) of 136 patients undergoing resection were seizure-free after resection. An additional 38 patients (28{\%}) had a significant reduction in seizures. The mean follow-up was 51 ± 30 months. The duration of monitoring, bone flap replacement, number of electrodes, and perioperative corticosteroids were not associated with infection or complication. Conclusion: Subdural grid monitoring for identification an epileptogenic focus is high yield, revealing a focus in 79{\%} of monitoring sessions. Complications rarely result in permanent morbidity (1.5{\%}). Surgical outcome indicated that 74{\%} of patients experienced a favorable reduction in seizure tendency.",
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