Authors :
Presenting Author: Jiahao Chen, BS – University of Pittsburgh Medical Center
Thandar Aung, MD, MS – University of Pittsburgh
Theodora Constantine, MPAS, PA-C – University of Pittsburgh Medical Center
Jorge Gonzalez-martinez,, MD, PhD – University of Pittssburgh Medical Center
Rationale: Numerous studies have demonstrated the safety and efficacy of SEEG electrode implantation; however, there is a notable paucity of research focused on the removal aspect and its associated complications. SEEG electrodes are removed in an intraoperative clinical setting, however the feasibility and comparative safety of an extra operative, bedside removal has not been well-documented. Our study thus investigates the feasibility of an extraoperative bedside approach, comparing intraoperative and bedside extra-operative SEEG removal complications-- and discussing the potential advantages to both approaches.
Methods: This is a retrospective study. A total of 117 consecutive patients who have previously undergone SEEG electrode implantation and removal at the University of Pittsburgh Medical Center were included. All patients were evaluated for: number of SEEG electrodes implanted and their respective cortical region, days spent post-implant to discharge, age at time of implant, gender, unilateral or bilateral electrode lateralization, the use of sedation, and complications related to electrode extraction. All courses of stay along with radiographic images were carefully investigated.
Results: We report similar patient demographic profiles for our two groups. A total of 101 patients (1,426 electrodes) were removed intraoperatively, and 16 patients (198 electrodes) were removed extra operatively. Statistical testing reveals no significant differences in complication rates between intraoperative and extraoperative patients, respectively low at 1.98% and 0.00%, for a combined total of 1.71%. Notably, zero cases of infection were observed. Additionally, between the two groups, statistical significance was observed in terms of sedation utility rates (intraoperatively, 92.1%, and extra operatively 0%). A statistical difference was also found in terms of cortical distribution of SEEG electrodes, however no statistical differences were found in the average electrodes implanted per region per patient.
Conclusions:
Our study suggests a significantly lower use of sedation in extra operative patients, which may contribute to patient comfort by continuing their course of treatment without additional sedatives. Additionally, we discuss the potential advantages of extra operative removal– eliminating the need for an operating room (OR) and it’s staffing resources, which may thus avoid OR delays and contribute to shorter lengths of stay. Given our results, and provided there are no other contraindicating patient factors, we conclude that the extra operative removal of SEEG electrodes is not associated with higher rates of complications and may be a safe alternative method while optimizing patient flow in an epilepsy monitoring unit.
Funding: This research received no specific grant from any funding agency in the public or commercial sectors.