COMPLICATIONS OF INVASIVE SUBDURAL GRID MONITORING IN CHILDREN
Abstract number :
3.244
Submission category :
Year :
2002
Submission ID :
3017
Source :
www.aesnet.org
Presentation date :
12/7/2002 12:00:00 AM
Published date :
Dec 1, 2002, 06:00 AM
Authors :
James T. Rutka, Cagatay Onal, Hiroshi Otsubo, Carter Snead, Shelly Weiss. Neurosurgery, The Hospital for Sick Children, Toronto, Ontario, Canada
RATIONALE: To evaluate the complications of invasive subdural grid monitoring during epilepsy surgery in children.
METHODS: We retrospectively reviewed the records of 35 consecutive children with intractable localization-related epilepsy who underwent invasive video EEG (IVEEG) with subdural grid electrodes at The Hospital for Sick Children between 1996 - 2001. Following subdural grid monitoring and the identification of the epileptic regions, cortical excisions and/or multiple subpial transections (MSTs) were performed. Complications after these procedures were then categorized as either surgical or neurological.
RESULTS: There were 17 males and 18 females with a median age of 11.7 years. The duration of epilepsy before surgery varied between 2 and 17 years (mean 8.3 years). Fifteen children (43%) had prior surgical procedures for epilepsy. The number of electrodes on the grids ranged from 40 to 117 (mean 95). During IVEEG, CSF leaks occurred in 7 patients. Cerebral edema (5 patients), subdural hemorrhage (5) and intracerebral hematoma (3) were observed on post-procedural imaging studies but did not require surgical intervention. Hypertrophic scars on the scalp were observed in 9 patients. There were three infections including one osteomyelitis, and two superficial wound infections. Blood loss and subsequent blood transfusion correlated directly with the size of and number of electrodes on the grids (p[lt]0.001). Transient unilateral motor weakness (24 patients), dysphasia (18) and facial weakness (17) were the most common neurological deficits after cortical excision and MSTs. One child had exacerbation of a pre-operative dysphasia which was permanent. Twenty-nine children derived significant benefit from cortical resections and MSTs with more than 50% reduction of seizures and a mean follow-up period of 30 months.
CONCLUSIONS: Our study suggests that carefully selected pediatric patients with intractable epilepsy can benefit from subdural invasive monitoring procedures with definite but acceptable risks.