Rationale and Safety of Pulvinar Thalamus Depth Electrode Implantation Using the SEEG Methodology
Abstract number :
3.438
Submission category :
9. Surgery / 9A. Adult
Year :
2022
Submission ID :
2232995
Source :
www.aesnet.org
Presentation date :
12/5/2022 12:00:00 PM
Published date :
Nov 22, 2022, 05:29 AM
Authors :
Jasmine Hect, BS – University of Pittsburgh Medical Center; Arka Mallela, MD, MS – Neurological Surgery – University of Pittsburgh; Michael Pupi, BS – Neurological Surgery – University of Pittsburgh; Austin Anthony, BS – Neurological Surgery – University of Pittsburgh; David Fogg, BS – Neurological Surgery – University of Pittsburgh; Hussam Abou-Al-Shaar, MD – Neurological Surgery – University of Pittsburgh; Jorge Gonzalez-Martinez, MD, PhD – Neurological Surgery – University of Pittsburgh
This is a Late Breaking abstract
Rationale: Stereoencephalography (sEEG) of the pulvinar thalamus may be utilized to describe and interrogate the involvement of subcortical areas in the organization of the epileptiform activity. Pulvinar thalamus sEEG neuromonitoring can assist in differentiating seizure networks involving the thalamus in posterior quadrant seizures and guide further surgical decision-making, including neuromodulation. The rationale and safety of robotic-assisted subcortical sEEG implantation to the pulvinar thalamic nucleus has not been described previously.
Methods: Retrospective chart review of epilepsy history, electrode coverage, rationale and complication incidence was performed for 70 patients with drug-resistant epilepsy who underwent sEEG at the University of Pittsburgh Medical Center. Twenty-six patients (37%) were identified with pulvinar thalamus implantation. The pulvinar exploration was achieved by extending the depth of electrode implantations in the posterior perisylvian areas, with no additional electrodes implanted for mapping thalamic areas exclusively. The decision to extend the implantation to the thalamic regions was part of the standard care. Descriptive statistics were used to summarize the incidence of post-implantation hemorrhage overall and for pulvinar thalamus electrodes.
Results: Twenty-six patients (aged 20-69) underwent pulvinar thalamus sEEG as part of their intracranial monitoring plan. In this group, no patients developed radiological intraparenchymal hemorrhages or any other adverse events related to thalamic electrodes. Regarding radiological finding across all sEEG patients implanted during the same period, three patients (4.3%) experienced significant post-implantation subdural hemorrhage (of which 2 required evacuation) and two (2.8%) experienced intraparenchymal hemorrhage of which none required intervention. Two patients subsequently received pulvinar responsive neurostimulation.
Conclusions: sEEG monitoring of the pulvinar thalamus in patients with drug-resistant epilepsy is a safe approach for mapping the epileptic network and interrogating the efficacy of thalamic neuromodulation in posterior quadrant epilepsies. Based on our institutional experience, pulvinar monitoring does not confer additional risk for hemorrhage.
Funding: None
Surgery