Abstracts

Rationale: The minimally invasive diagnostic method of stereo-electroencephalography (SEEG) is gaining popularity in the United States, and patient tolerability when compared to the more established method using subdural grids and strips, which requires a full craniotomy, can be a factor in clinical decision-making.  We compared pain management in patients undergoing invasive monitoring using either method, as a quantitative measure of patient tolerability. Methods: We retrospectively reviewed electronic medical records of adult patients undergoing SEEG monitoring at our center. Age-matched control patients were randomly selected from a pool of patients who underwent subdural monitoring at the center over the last 10 years.  Results: 34 patients ≥18 (average age 33) underwent SEEG between January 2015 and June 2017. Complete electronic medical records were readily available for 28 of those (18M, 10F).  Age-matched control patients were randomly selected. Results are summarized in Table 1. Length of stay was similar between the two groups, but the SEEG patients had on average more days of mild pain or pain freedom, and fewer days when they experienced severe pain levels. Narcotics were needed for pain control in all but 1 of the control patients, but only 18 out 28 SEEG patients required narcotics, and the overall doses were lower in the SEEG group. At the time of electrode removal, all but 1 control patients underwent a treatment procedure, compared to only 9 patients in the SEEG group. Conclusions: As expected, the patients undergoing SEEG experienced less pain during monitoring, and a significant difference was found between the two groups in the use of narcotics, where nearly a third of SEEG patients did not require any, compared to only 1 patient in the control group. While the minimally invasive nature of SEEG is a clear advantage, especially if a large craniotomy may not be required for treatment procedure at a later date, pain levels for both groups were well managed and many of the patients who had subdural monitoring were also mostly pain free for the majority of their stay, although heavier use of narcotics was noted in that group. These results can be used as reference in clinical decision making, as pain management during invasive monitoring is a frequent concern among patients and their families. Funding: The study was entirely supported by the Department of Neurosurgery at Mount Sinai Health System.