Clinical Outcomes Following Invasive Monitoring with Subdural Electrodes or Stereoelectroencephalography: A Twenty-Year, Single-Institution Experience
Abstract number :
3.322
Submission category :
9. Surgery / 9B. Pediatrics
Year :
2021
Submission ID :
1825855
Source :
www.aesnet.org
Presentation date :
12/6/2021 12:00:00 PM
Published date :
Nov 22, 2021, 06:50 AM
Authors :
Madison Remick, BS, MS - University of Pittsburgh School of Medicine; Emefa Akwayena, BS - Research Coordinator, Department of Neurosurgery, University of Pittsburgh; Akanksha Chilukuri, BS - Medical Student, University of Pittsburgh School of Medicine; Taylor Abel, MD - Department of Neurosurgery - University of Pittsburgh
Rationale: Numerous studies show that surgical resection significantly reduces seizure frequency when compared to continued antiseizure drug therapy. Invasive monitoring with either subdural electrodes (SDE) or stereoelectroencephalography (sEEG) is often necessary to identify the epileptogenic zone (EZ) to guide resective surgery. However, the relative effectiveness of SDE and sEEG is debated. While recent studies suggest that sEEG has a more favorable safety profile and potentially a higher rate of post-resection seizure freedom, characterizing the clinical outcomes of SDE and sEEG patients is crucial to understanding their optimal usage. Here, we compare outcomes of SDE- and sEEG-monitored patients at UPMC Children’s Hospital of Pittsburgh to examine the relative safety and efficacy of these techniques.
Methods: We performed a retrospective review of invasive monitoring evaluations at UPMC Children’s Hospital of Pittsburgh from February 2000 through March 2021. Individual patient data was extracted regarding sex, age at surgery, invasive monitoring type, associated pathology, sEEG- and SDE-related complications, and post-monitoring resection status. Independent sample t-tests were performed to examine the differences between groups.
Results: A total of 167 records of patients aged 1 through 21 years undergoing invasive monitoring for evaluation of drug resistant epilepsy were reviewed. Of this cohort, 133 (80%) patients underwent SDE, and 34 (20%) patients underwent sEEG. The average age significantly differed between groups (SDE 10.88 + 4.88 years; sEEG 13.56 + 4.52 years; p=0.004, 95% CI -4.509—-0.857), however the age distribution was similar. There was no statistically significant difference in the rate of resection between SDE and sEEG patients (p=0.095, 95% CI -0.026—0.317). Specifically, 75.19% of SDE patients (+3.76%) underwent subsequent resection as compared to 60.61% (+8.64%) of sEEG patients. However, there was a statistically significant difference in the rate of complications between groups (SDE 22.56% +3.64%; sEEG 5.88% +4.10%; p< 0.001, 95% CI 0.018—0.315).
Surgery