Stereoelectroencephalography in the Very Young
Abstract number :
2.293
Submission category :
9. Surgery / 9B. Pediatrics
Year :
2022
Submission ID :
2204611
Source :
www.aesnet.org
Presentation date :
12/4/2022 12:00:00 PM
Published date :
Nov 22, 2022, 05:25 AM
Authors :
Benjamin Kennedy, MD – Children's Hospital of Philadelphia; Raphia Rahman, MBS – Children's Hospital of Philadelphia; Kathleen Galligan, PA-C – Children's Hospital of Philadelphia; Joshua Katz, MD – Rutgers Robert Wood Johnson Medical School; Sudha Kessler, MD – Children's Hospital of Philadelphia; Peter Madsen, MD – Children's Hospital of Philadelphia; Samuel Tomlinson, MD – University of Pennsylvania; Alexander Tucker, MD – Children's Hospital of Philadelphia
Rationale: Stereoelectroencephalography (SEEG) is a widespread technique utilized for localizing seizure onset zones prior to surgical resection. However, its use has traditionally been avoided in children under age two due to concerns regarding pin fixation in the immature skull, intraoperative and postoperative electrode bolt security, and stereotactic registration accuracy. In this retrospective study, we describe our experience using SEEG in patients under two years old, with a focus on safety, feasibility, accuracy, and surgical outcomes.
Methods: A retrospective review was performed of children who underwent SEEG under two years of age at Children’s Hospital of Philadelphia (CHOP) between November 2017 and July 2021. Data on clinical characteristics, surgical procedure, imaging results, electrode accuracy measurements, and postoperative outcomes were examined.
Results: Five patients under age two years underwent SEEG during the study period (median age 20 months, range 17-23 months). Mean age of seizure onset was nine months. Developmental delay was present in all patients, and epilepsy-associated genetic diagnoses included tuberous sclerosis (n=1), KAT6B (n=1), and NPRL3 (n=1). Cortical lesions included tubers from tuberous sclerosis (n=1), mesial temporal sclerosis (n=1), and cortical dysplasia (n=3). The mean number of electrodes placed was 11 (range, 6-21 electrodes). Bilateral electrodes were placed in one patient. Seizure onset zones were identified in all cases. There were no SEEG-related complications, including skull fracture, electrode misplacement, hemorrhage, infection, cerebrospinal fluid leak, electrode pullout, neurological deficit, or death. The mean target point error (TPE) for all electrodes was 1.0 mm. All patients proceeded to resective surgery, with a mean follow-up of 21 months (range, 8-53 months). All patients achieved favorable epilepsy outcome, including Engel Class 1A (n=2), 1C (n=1), 1D (n=1), and 2A (n=1).
Conclusions: SEEG may be safely, accurately, and effectively utilized in children under age two with good postoperative outcomes using standard stereo EEG equipment. With minimal modification of technique, this procedure is feasible in those with immature skulls and guides the epilepsy team’s decision-making for early and optimal treatment of refractory epilepsy through effective localization of seizure onset zones.
Funding: None
Surgery