Abstract
The utilization of epidural electrodes in the preoperative evaluation of intractable epilepsy is a valuable but underrepresented tool. In recent years, we have adapted the use of cylindrical epidural 1-contact electrodes (1-CE) instead of Peg electrodes. 1-CEs are more versatile since their explantation is a possible bedside procedure. Here we report our experience with 1-CEs as well as associated technical nuances. This retrospective analysis included 56 patients with intractable epilepsy who underwent epidural electrode placement for presurgical evaluation at the Department of Neurosurgery at the Charité University Hospital from September 2011 to July 2021. The median age at surgery was 36.3 years (range: 18–87), with 30 (53.6%) female and 26 (46.4%) male patients. Overall, 507 electrodes were implanted: 93 Fo electrodes, 33 depth electrodes, and 381 epidural electrodes, with a mean total surgical time of 100.5 ± 38 min and 11.8 ± 5 min per electrode. There was a total number of 24 complications in 21 patients (8 Fo electrode dislocations, 6 CSF leaks, 6 epidural electrode dislocations or malfunction, 3 wound infections, and 2 hemorrhages); 11 of these required revision surgery. The relative electrode complication rates were 3/222 (1.4%) in Peg electrodes and 3/159 (1.9%) in 1-CE. In summary, epidural recording via 1-CE is technically feasible, harbours an acceptable complication rate, and adequately replaces Peg electrodes.
Highlights
Despite the vast range of pharmacological treatment options, the limited efficacy of antiepileptic drugs remains a challenge in epilepsy patients
A third of patients suffering from epilepsy cannot be adequately managed with antiepileptic drugs, sometimes necessitating more invasive approaches as a last resort to localize the seizure focus [1–3]
Several modalities of intracranial EEG recording have been in use in epilepsy surgery, including (Foramen ovale) Fo electrodes, subdural grids, depth electrodes, and epidural electrodes, each presenting with a unique subset of advantages, requirements, limitations, and risks, making an individual evaluation of each patient, and matching the most suitable modality necessary
Summary
Despite the vast range of pharmacological treatment options, the limited efficacy of antiepileptic drugs remains a challenge in epilepsy patients. Several modalities of intracranial EEG recording have been in use in epilepsy surgery, including (Foramen ovale) Fo electrodes, subdural grids, depth electrodes, and epidural electrodes, each presenting with a unique subset of advantages, requirements, limitations, and risks, making an individual evaluation of each patient, and matching the most suitable modality necessary. Being the first modality ever utilized in series for invasive EEG monitoring of epilepsy patients, epidural electrodes have been around since the late 1930s, described by Penfield and Jasper [5]. Less invasive than most other modalities, epidural electrodes are usually arranged as single contact units and can be inserted through burr. Less invasive than most other modalities, epidural electrodes are usually arranged as single contact units and can be inserted through burr or twist drill holes [6–9].
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