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  • Is SEEG safe? A Systematic Review and Meta-Analysis of Stereo-Electroencephalography Related Complications

    Final Number:
    373

    Authors:
    Jeffrey Paul Mullin MD MBA; Michael Shriver BS; Soha Abdu Alomar MD, FRCSC, MPH; Imad Najm MD; Jorge Alvaro Gonzalez-Martinez MD, PhD

    Study Design:
    Other

    Subject Category:

    Meeting: Congress of Neurological Surgeons 2016 Annual Meeting

    Introduction: Stereotacticelectroencephalography (SEEG) is a procedure performed in order to define the epileptogenic zone in medically refractory epilepsy patients. Despite not requiring a craniotomy, intra-cerebral electrodes have gained a reputation of a “relatively high morbidity” associated with their placement. The goal of this study is to be the first to quantitatively review the incidence of various surgical complications associated with SEEG electrode implantation in the literature and to provide a summary estimate.

    Methods: The systematic review was conducted following Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA). We conducted MEDLINE, SCOPUS, and Web of Science database searches with the search algorithm. We analyzed complication rates using a fixed-effects model with inverse variance weighting. Calculations for the meta-analysis and construction of forest plots were completed. The principal summary measures were the effect summary value and 95% confidence intervals (CIs).

    Results: The initial 1,901 retrieved citations were reviewed. After removing 787 duplicates, the titles and abstracts of 1,114 publications were screened15. After excluding 1,057 citations, which did not meet our search criteria, the full texts were assessed in the resulting 57 articles for eligibility criteria. The most common complications were hemorrhagic (1.0%, 95% CI 0.6-1.4%) or infectious (0.8%, 95 CI% 0.3-1.2%). Five mortalities were identified (0.3%, 95 CI% -0.1-0.6%). Overall, our analysis identified 121 surgical complications related to SEEG insertion and monitoring (1.3%, 95 CI% 0.9-1.7%).

    Conclusions: This review represents a comprehensive estimation of the actual incidence of complications related to SEEG. We report a rate substantially lower than the complication rates reported for other methods of extra-operative invasive monitoring. This data should alleviate concerns of some regarding the safety of the “stereotactic” method, allowing a better decision process among the different methods of invasive monitoring and ameliorating the fear associated with the placement of depth electrodes.

    Patient Care: By demonstrating safety of SEEG, we hope more patients with medically refractory epilepsy will be offered this safe technique; ultimately leading to seizure freedom.

    Learning Objectives: By the conclusion of this session, participants should be able to 1) understand the overall safety profile of SEEG. 2) understand the greatest risks of SEEG 3) feel comfortable discussing SEEG with their patients.

    References: 1. Bancaud J, Talairach J. Functional organization of the supplementary motor area. Data obtained by stereo-E.E.G. Neurochirurgie 1967 May-Jun;13(3):343-356. 2. Chassoux F, Devaux B, Landré E, et al. Stereoelectroencephalography in focal cortical dysplasia: a 3D approach to delineating the dysplastic cortex. Brain 2000 Aug;123 ( Pt 8):1733-1751 3. Talairach J, Bancaud J, Bonis A, et al. Surgical therapy for frontal epilepsies. Adv Neurol 1992;57:707-732. 4. Bancaud J. Epilepsy after 60 years of age. Experience in a functional neurosurgical department. Sem Hop 1970 Nov 28;46(48):3138-3140. 5. Bancaud J, Angelergues R, Bernouilli C, et al. Functional stereotaxic exploration (SEEG) of epilepsy. Electroencephalogr Clin Neurophysiol 1970 Jan;28(1):85-86. 6. Cossu M, Cardinale F, Castana L, et al. Stereo-EEG in children. Childs Nerv Syst 2006 Aug;22(8):766-778. 7. Quesney LF, Gloor P. Localization of epileptic foci. Electroencephalogr Clin Neurophysiol Suppl 1985;37:165-200. 8. De Almeida AN, Olivier A, Quesney F, et al. Efficacy of and morbidity associated with stereoelectroencephalography using computerized tomography--or magnetic resonance imaging-guided electrode implantation. J Neurosurg 2006 Apr;104(4):483-487. 9. Gonzalez-Martinez J, Bulacio J, Alexopoulos A, et al. Stereoelectroencephalography in the "difficult to localize" refractory focal epilepsy: early experience from a North American epilepsy center. Epilepsia 2013 Feb;54(2):323-330. 10. Cossu M, Cardinale F, Castana L, et al. Stereoelectroencephalography in the presurgical evaluation of focal epilepsy: a retrospective analysis of 215 procedures. Neurosurgery 2005 Oct;57(4):706-718; discussion 706-718. 11. Gonzalez-Martinez J, Mullin J, Vadera S, et al. Stereotactic placement of depth electrodes in medically intractable epilepsy. J Neurosurg 2014 Mar;120(3):639-644. 12. Cross JH. Epilepsy surgery in childhood. Epilepsia 2002;43 Suppl 3:65-70. 13. DeLong WB, Polissar N, Neradilek B. Timing of surgery in cauda equina syndrome with urinary retention: meta-analysis of observational studies. J Neurosurg Spine 2008;8:305-320. 14. Group OLoEW. The Oxford Levels of Evidence 2, in: Oxford Centre for Evidence-Based Medicine 15. Moher D, Liberati A, Tetzlaff J, Altman DG. Preferred reporting items for systematic reviews and meta-analyses: the PRISMA statement. BMJ 2009;339. 16. Neyeloff JL, Fuchs SC, Moreira LB. Meta-analyses and Forest plots using a microsoft excel spreadsheet: step-by-step guide focusing on descriptive data analysis. BMC Res Notes 2012;5:52. 17. Dorfer C, Stefanits H, Pataraia E, et al. Frameless stereotactic drilling for placement of depth electrodes in refractory epilepsy: operative technique and initial experience. Neurosurgery 2014 Dec;10 Suppl 4:582-590; discussion 590-591. 18. Balanescu B, Franklin R, Ciurea J, et al. A personalized stereotactic fixture for implantation of depth electrodes in stereoelectroencephalography. Stereotact Funct Neurosurg 2014;92(2):117-125. 19. Cardinale F, Cossu M, Castana L, et al. Stereoelectroencephalography: surgical methodology, safety, and stereotactic application accuracy in 500 procedures. Neurosurgery 2013 Mar;72(3):353-366; discussion 366. 20. Serletis D, Bulacio J, Bingaman W, et al. The stereotactic approach for mapping epileptic networks: a prospective study of 200 patients. J Neurosurg 2014 Nov;121(5):1239-1246. 21. Dylgjeri S, Taussig D, Chipaux M, et al. Insular and insulo-opercular epilepsy in childhood: an SEEG study. Seizure 2014 Apr;23(4):300-308. 22. Ross DA, Brunberg JA, Drury I, Henry TR. Intracerebral depth electrode monitoring in partial epilepsy: the morbidity and efficacy of placement using magnetic resonance image-guided stereotactic surgery. Neurosurgery 1996 Aug;39(2):327-333; discussion 333-334. 23. Espinosa J, Olivier A, Andermann F, et al. Morbidity of chronic recording with intracranial depth electrodes in 170 patients. Stereotact Funct Neurosurg 1994;63(1-4):63-65. 24. Guenot M, Isnard J, Ryvlin P, Fischer C, Ostrowsky K, Mauguiere F, Sindou M. Neurophysiological monitoring for epilepsy surgery: the Talairach SEEG method. StereoElectroEncephaloGraphy. Indications, results, complications and therapeutic applications in a series of 100 consecutive cases. Stereotact Funct Neurosurg. 2001;77(1-4):29-32. PubMed PMID: 12378053. 25. Munari C, Hoffmann D, Francione S, et al. Stereo-electroencephalography methodology: advantages and limits. Acta Neurol Scand Suppl 1994;152:56-67, discussion 68-69. 26. McGonigal A, Bartolomei F, Régis J, et al. Stereoelectroencephalography in presurgical assessment of MRI-negative epilepsy. Brain 2007 Dec;130(Pt 12):3169-3183. 27. So N, Gloor P, Quesney LF, et al. Depth electrode investigations in patients with bitemporal epileptiform abnormalities. Ann Neurol 1989 May;25(5):423-431. 28. Vadera S, Mullin J, Bulacio J, et al. Stereoelectroencephalography following subdural grid placement for difficult tolocalize epilepsy. Neurosurgery 2013 May;72(5):723-729; discussion 729. 29. Van Roost D, Solymosi L, Schramm J, et al. Depth electrode implantation in the length axis of the hippocampus for the presurgical evaluation of medial temporal lobe epilepsy: a computed tomography-based stereotactic insertion technique and its accuracy. Neurosurgery 1998 Oct;43(4):819-826; discussion 826-827. 30. Nowell M, Rodionov R, Diehl B, et al. A novel method for implementation of frameless StereoEEG in epilepsy surgery. Neurosurgery 2014 Dec;10 Suppl 4:525-533; discussion 533-534. 31. Olivier A, Gloor P, Quesney LF, Andermann F. The indications for and the role of depth electrode recording in epilepsy. Appl Neurophysiol 1983;46(1-4):33-36. 32. Kratimenos GP, Thomas DG, Shorvon SD, Fish DR. Stereotactic insertion of intracerebral electrodes in the investigation of epilepsy. Br J Neurosurg 1993;7(1):45-52. 33. Arya R, Mangano FT, Horn PS, et al. Adverse events related to extraoperative invasive EEG monitoring with subdural grid electrodes: a systematic review and meta-analysis. Epilepsia 2013 May;54(5):828-839.. 34. Tebo CC, Evins AI, Christos PJ, et al. Evolution of cranial epilepsy surgery complication rates: a 32-year systematic review and meta-analysis. J Neurosurg 2014 Jun;120(6):1415-1427. 35. Tanriverdi T, Ajlan A, Poulin N, Olivier A. Morbidity in epilepsy surgery: an experience based on 2449 epilepsy surgery procedures from a single institution. J Neurosurg 2009 Jun;110(6):1111-1123. 36. Maxwell RE, Gates JR, Fiol ME, et al. Clinical evaluation of a depth electroencephalography electrode. Neurosurgery 1983 May;12(5):561-564. 37. Munari C, Giallonardo AT, Brunet P, et al. Stereotactic investigations in frontal lobe epilepsies. Acta Neurochir Suppl (Wien) 1989;46:9-12. 38. Abhinav K, Prakash S, Sandeman DR. Use of robot-guided stereotactic placement of intracerebral electrodes for investigation of focal epilepsy: initialexperience in the UK. Br J Neurosurg 2013 Oct;27(5):704-705. 39. Blauwblomme T, David O, Minotti L, et al. Prognostic value of insular lobe involvement in temporal lobe epilepsy: a stereoelectroencephalographic study. Epilepsia 2013 Sep;54(9):1658-1667. 40. Cossu M, Fuschillo D, Cardinale F, et al. Stereo-EEG-guided radio-frequency thermocoagulations of epileptogenic grey-matter nodular heterotopy. J Neurol Neurosurg Psychiatry 2014 Jun;85(6):611-617. 41. Dorfmüller G, Ferrand-Sorbets S, Fohlen M, et al. Outcome of surgery in children with focal cortical dysplasia younger than 5 years explored by stereo-electroencephalography. Childs Nerv Syst 2014 Nov;30(11):1875-1883. 42. Ortler M, Sohm F, Eisner W, et al. Frame-based vs frameless placement of intrahippocampal depth electrodes in patients with refractory epilepsy: a comparative in vivo (application) study. Neurosurgery 2011 Apr;68(4):881-887; discussion 887. 43. Taussig D, Chipaux M, Lebas A, et al. Stereo-electroencephalography (SEEG) in 65 children: an effective and safe diagnostic method for pre-surgical diagnosis, independent of age. Epileptic Disord 2014 Sep;16(3):280-295. 44. Munyon C, Sweet J, Luders H, et al. The 3-dimensional grid: a novel approach to stereoelectroencephalography. Neurosurgery 2015 Mar;11 Suppl 2:127-133; discussion 133-134. 45. Cardinale F, Cossu M. SEEG has the lowest rate of complications. J Neurosurg 2015 Feb;122(2):475-477. 46. Hader WJ, Tellez-Zenteno J, Metcalfe A, Hernandez-Ronquillo L, Wiebe S, Kwon CS, Jette N. Complications of epilepsy surgery: a systematic review of focal surgical resections and invasive EEG monitoring. Epilepsia. 2013 May;54(5):840-7.doi: 10.1111/epi.12161. Epub 2013 Apr 3. Review. PubMed PMID: 23551133.

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