Stereoencephalography Planning for Phase 2 Monitoring and Risk for Hemorrhage
Abstract number :
3.334
Submission category :
9. Surgery / 9C. All Ages
Year :
2022
Submission ID :
2204855
Source :
www.aesnet.org
Presentation date :
12/5/2022 12:00:00 PM
Published date :
Nov 22, 2022, 05:26 AM
Authors :
Nancy McNamara, MD – University of Michigan, Michigan Medicine; Allyson Alexander, MD PhD – Neurosurgery, Division of Pediatric Neurosurgery – University of Colorado Anschutz Medical Campus; Michael Ciliberto, MD – University of Iowa Stead Family Children’s Hospital; Krista Eschbach, MD – Departments of Pediatrics, Section of Neurology – University of Colorado Anschutz Medical Campus; Erin Fedak Romanowski, DO – Associate Clinical Professor, Pediatrics, University of Michigan, Michigan Medicine; Hugh Garton, MD PhD – Neurosurgery – University of Michigan, Michigan Medicine; Daniel Hansen, MD – Cook Children’s Medical Center, Ft Worth, TX; Jaes Jones, MD MS – Neurosurgery Resident, Neurosurgery, University of Michigan, Michigan Medicine; Harlen McCafferty, MS – Biostatistics and Data Management Unit, Pediatrics, University of Michigan; Joffre Olaya, MD – Division of Neurosurgery – Children’s Hospital of Orange County; Adam Ostendorf, MD – Pediatrics – Nationwide Children's Hospital and Ohio State University, Columbus; M Scott Perry, MD – Cook Children’s Medical Center, Ft Worth, TX; Shilpa Reddy, MD – 6. Division of Pediatric Neurology/Department of Pediatrics – Vanderbilt University Medical Center; Oren Sagher, MD – Neurosurgery – University of Michigan, Michigan Medicine; Garnett Smith, MD – Pediatrics – University of Michigan, Michigan Medicine; Priyamvada Tatachar, MD – Lurie Children's Hospital; Lily Wong-Kisiel, MD – Department of Neurology – Mayo Clinic
Rationale: Stereoencephalography (sEEG) a frequently used technique for invasive monitoring in patients with intractable epilepsy. SEEG has lower morbidity than subdural electrodes with overall risk of hemorrhage 1% per electrode. Preoperative planning is crucial to avoid hemorrhages but lacks standardization. We evaluated dependent variables amongst 8 epilepsy centers and their correlation with risk of hemorrhage in patients who underwent sEEG implantation.
Methods: The study was IRB exempt. An anonymized RedCap Survey was sent to 16 institutions in the United States. Data were collected from patients who underwent sEEG placement between January 1, 2017, and October 1, 2021. Data collected included the number of patients (pediatric and adult) who underwent sEEG placement, number of asymptomatic and symptomatic hemorrhages, personnel involved in the planning process, electrode diameter, type of preoperative planning imaging (CTA, angiogram, MR).
Results: A total of 16 surveys were returned with 8 completed surveys. A total of 349 adults had 3250 electrodes placed and 238 children had 2365 electrodes over the 8 centers. Two of the 8 centers were unable to quantify the total number of electrodes placed. Six centers used robotic assistance for placement of electrodes. SEEG planning was performed by the epileptologist alone at 1 site, the neurosurgeon at 3 sites, the epileptologist + neurosurgeon at 2 sites, biomedical engineer and epileptologist at 1 site, and biomedical engineer + epileptologist + neurosurgeon at 1 site. Only 1 site did not perform a double check of trajectories prior to placement. Pre-planning imaging was done by CTA at 3 sites. No sites used conventional angiogram. One site used an MRA for preplanning. Nearly every center used 0.8 mm electrodes or smaller (7/8); one site used >1 mm electrodes. Overall hemorrhage rates per electrode were low (mean overall-0.49%). Per the 6 sites that included quantification of electrodes placed in every case, overall asymptomatic hemorrhage rate was 0.46% in adults and 0.25% in pediatrics. There were a total of 10 symptomatic hemorrhages amongst all cases; this gave an overall risk of 0.18%. Individual hemorrhage rates per site are referenced below in table 1 and ranged from 0 to 1.29%. The site with the highest hemorrhage rate noted that all hemorrhages (2) occurred when using 1.2 mm electrodes and subsequently had 0 hemorrhages after transitioning to 0.8 mm electrodes. There was no difference in hemorrhage rate relating to preplanning personnel nor type of pre-implant imaging.
Conclusions: The sEEG planning process is variable among centers utilizing this technique. There was no significant difference in hemorrhage rate based pre-planning personnel or imaging; overall there was a low risk for hemorrhage. The highest rate of hemorrhage was related to electrode diameter. As we continue to utilize sEEG for invasive monitoring in patients with drug resistant epilepsy, future research should focus on reducing the risk of hemorrhage and define best practices for implantation in these patients.
Funding: Support for this project came from the Charles Woodson Fund for Clinical Research.
Surgery