Introduction: Many children with medically refractory epilepsy, who are candidates for epilepsy surgery, require placement of intracranial electrodes to further lateralize or localize their seizures. The variety of electrodes include subdural grid and strips as well as depth electrodes. These electrodes are left in situ over a week period, after which a decision about resective surgery is made. The factors influencing rate of postoperative infections associated with the procedure is unclear. This retrospective study reports the rate and nature of post operative infection in our pediatric neurosurgery center in relation to various patient factors.
Methods: We reviewed 198 consecutive patients who underwent insertion of intracranial electrodes between the 2001 and 2016 for variables: age, preoperative bloodwork, length of surgery, number of people present in the operating room, type and number of electrodes inserted, length of hospital stay, steroid use, anticonvulsant use, and postoperative prophylactic antibiotics. We used both univariate analysis (chi-squared test and discriminant analysis) and multivariate analysis (logistic regression) to examine how these factors may be related to postoperative surgical infection.
Results: There were eleven cases of postoperative surgical infections. All patients received postoperative prophylaxis, which consists of intravenous Vancomycin & Cefotaxime while the electrodes are in situ, intravenous Cloxacillin for 5 days after removal with a final switch to oral Cephalexin for an additional 5-7 days. Factors that significantly correlated with presence of infection included length of the insertion operation, number of people present in the operating room, as well as the number of depth electrodes.
Conclusions: The insertion procedure plays a critical role in the risk for postoperative surgical infection. Quantifying our infection rate and treatment can inform future prospective studies to reduce this morbidity in children undergoing intracranial electrocorticography.
Patient Care: Quantifying our infection rate and treatment can inform future prospective studies and protocol modifications to reduce postoperative infections in children undergoing intracranial electrocorticography.
Learning Objectives: By the conclusion of this session, participants should be able to identify factors that may contribute to postoperative surgical infection after intracranial electrocorticography monitoring.