The Feasibility of the Trans-Interhemispheric Stereo-Electroencephalography Approach for Medically Intractable Epilepsy
Abstract number :
1.334
Submission category :
9. Surgery / 9C. All Ages
Year :
2021
Submission ID :
1826439
Source :
www.aesnet.org
Presentation date :
12/4/2021 12:00:00 PM
Published date :
Nov 22, 2021, 06:54 AM
Authors :
Arka Mallela, MD - University of Pittsburgh Medical Center; Nikhil Sharma - School of Medicine - University of Pittsburgh; Hussam Abou-Al-Shaar - Department of Neurosurgery - University of Pittsburgh Medical Center; Nirav Barot - Department of Neurology - University of Pittsburgh Medical Center; Jorge Gonzalez-martinez - Department of Neurosurgery - University of Pittsburgh Medical Center
Rationale: Stereo-electroencephalography is an effective and safe method for invasive monitoring in patients with medically intractable epilepsy. Frequently, bilateral hemispheric explorations are necessary. Conventionally, monitoring bihemispheric epileptic networks requires bilateral lead placement. However, in the anterior and inferior frontal lobes, bilateral monitoring may be accomplished from the contralateral side via a single entry point as the falx is absent as a limiting structure. This use of trans-interhemispheric monitoring offers several advantages including sparing the need for additional entry points, a decreased risk of hemorrhage and infection and decreased operating room time. The feasibility of exploring bihemispheric regions with unilateral entry points is unclear. We aimed to define the feasibility of performing trans-interhemispheric SEEG electrode implantations in patients with medically intractable epilepsy.
Methods: In a retrospective case series, we examined five patients who underwent bilateral monitoring using contralateral sEEG lead placement and discuss the operative technique. We collected and analyzed patient demographics, epilepsy history, imaging, lead accuracy, epilepsy outcomes and adverse events.
Results: Five patients underwent contralateral monitoring, with a total of 16 leads (median 3 electrodes). Trajectory error was minimal (0.12mm) and operating room time was comparable to previous reports. All leads were placed without issue (i.e. no lead was aborted). There was no instances of electrode hemorrhage or other complication. All patients had successful localization of the epileptogenic zone.
Conclusions: The transhemispheric SEEG approach for bihemispheric monitoring through a unilateral entry point is a feasible method. Further study in larger populations is required to determine the safety profile and full indications of this method.
Funding: Please list any funding that was received in support of this abstract.: No specific funding was sought or received for this report.
Surgery