Trans-Falcine and Sub-Frontal Insertion of Contralateral Subdural and Depth Electrodes in Pediatric Epilepsy Surgery
Abstract number :
1.303
Submission category :
9. Surgery / 9B. Pediatrics
Year :
2016
Submission ID :
194214
Source :
www.aesnet.org
Presentation date :
12/3/2016 12:00:00 AM
Published date :
Nov 21, 2016, 18:00 PM
Authors :
Curtis Rozzelle, University of Alabama-Birmingham School of Medicine and Children's Hospital of Alabama; Jonathan Pindrik, Nationwide Children's Hospital and The Ohio State University Wexner Medical Center; Brandon Rocque, University of Alabama-Birmingham
Rationale: Phase II monitoring with intra-cranial electroencephalography (ICEEG) occasionally requires bilateral subdural (SD) grid, strip, and/or depth electrode coverage to rule out 1) false lateralization from phase I monitoring or 2) bilateral seizure onset. This study describes previously unreported techniques of trans-falcine and sub-frontal insertion of contralateral SD grids and depth electrodes for Phase II monitoring in pediatric epilepsy surgery. Methods: Patients (age < 19-years-old) with medically refractory epilepsy undergoing one-sided surgery for ipsilateral and contralateral ICEEG SD grid and/or depth electrode insertion at the authors' institution were retrospectively reviewed. Operative techniques included gentle subfrontal retraction for SD grid coverage of the contralateral orbito-frontal region. Trans-falcine approaches involved bipolar cauterization and sharp dissection of the anterior falx cerebri below the superior sagittal sinus. Creation of a falcine window allowed insertion of SD strip and depth electrodes for coverage of contralateral frontal regions. Results: Among 7 study patients reviewed since 2012, there were no new neurologic deficits related to contralateral ICEEG electrode insertion. Intra-operative events of ipsilateral frontal pole venous engorgement due to sacrifice of anterior bridging veins and avulsion of a contralateral bridging vein in the setting of prior anterior corpus callosotomy occurred in one patient each. All patients proceeded to Stage II surgery for resection of ipsilateral epileptogenic onset zones without adverse events. Conclusions: Trans-falcine and sub-frontal insertion of contralateral SD strip, grid, and depth electrodes represent previously unreported techniques of achieving bilateral coverage in Phase II monitoring for pediatric epilepsy surgery. For carefully selected individual patients this technique obviates the need for contralateral craniotomy and parenchymal exposure (or contralateral burr holes) with limited, remediable risks. Funding: None.
Surgery