Post-Operative Computed Tomography (CT) Following Stereotactic Electroencephalography (SEEG) Insertion: How Signficant Is the Effect of Electrode Artifact?
Abstract number :
3.35
Submission category :
9. Surgery / 9A. Adult
Year :
2019
Submission ID :
2422243
Source :
www.aesnet.org
Presentation date :
12/9/2019 1:55:12 PM
Published date :
Nov 25, 2019, 12:14 PM
Authors :
Jacob R. Lepard, University of Alabama at Birmingham; Esther B. Dupepe, University of Alabama at Birmingham; Matt Davis, University of Alabama at Birmingham; Nicole Bentley, University of Alabama at Birmingham; Kristen Riley, University of Alabama at Birm
Rationale: In the last decade North American epilepsy centers have increasingly utilized robotically inserted stereotactic electroencephalography (SEEG) for localization of the epileptogenic zone. Here, we report the incidence of minor surgical complications related to SEEG insertion. The incidences were calculated using both post-implant and post-explantation computed tomography (CT) imaging. The respective incidence rates from the two imaging modalities were compared to determine if significant adverse effects were undiagnosed due to significant metal artifact on post-implantation imaging. Methods: We retrospectively evaluated all adult patients with medically refractory epilepsy who underwent SEEG implantation at our level 4 epilepsy center from January 2013 to January 2018. Post-implantation and post-explantation CT images were reviewed for evidence of hemorrhage, hematoma, or edema. Cumulative incidences were calculated and compared with Fisher's Exact Test. Results: We analyzed 446 electrodes in 40 patients. The cumulative incidences of epidural hematoma, subdural hematoma, and intracerebral hemorrhage (ICH) were not significantly different from each other between the two imaging timepoints. There was a significant difference in successfully diagnosed edema (p = 0.001) and punctate ICH (p = 0.003). Additionally, there was a trend toward a significant difference in diagnostic utility for SAH following the removal of electrode artifact, p = 0.05. Though there were significantly more hemorrhages diagnosed on de-artifacted post-explanation images, none were symptomatic or of clinical significance. Conclusions: SEEG remains a safe diagnostic modality for medically refractory epilepsy. While metal artifact following SEEG insertion creates some distortion and a relative limitation in diagnosing hemorrhage or edema, it does not result in the underdiagnosis of clinically significant complications. Given that none of the missed hemorrhages resulted in clinically meaningful complications our data lends further support that post-implantation CT is an adequate diagnostic tool in the post-operative period. Funding: No funding
Surgery