Complications of invasive subdural electrode monitoring at St. Louis Children's Hospital, 1994-2005.
OBJECTIVE
The purpose of this study was to better define the incidence of complications associated with placement of subdural electrodes for localization of seizure foci and functional mapping in children.


METHODS
The authors retrospectively reviewed the records of 112 consecutive patients (53 boys, 59 girls; mean age 10.9 years, range 10 months-21.7 years) with medically intractable epilepsy who underwent invasive monitoring at the Pediatric Epilepsy Center at St. Louis Children's Hospital between January 1994 and July 2005. There were 122 implantation procedures (85 grids and strips, 32 strips only, five grids only, four with additional depth electrodes), with a mean monitoring period of 7.1 days (range 2-21 days). Operative complications included the need for repeated surgery for additional electrode placement (5.7%); wound infection (2.4%); cerebrospinal fluid leak (1.6%); and subdural hematoma, symptomatic pneumocephalus, bone flap osteomyelitis, and strip electrode fracture requiring operative retrieval (one patient [0.8%] each). There were four cases of transient neurological deficit (3.3%) and no permanent deficit or death associated with invasive monitoring.


CONCLUSIONS
Placement of subdural grid and strip electrodes for invasive video electroencephalographic monitoring is generally well tolerated in the pediatric population. The authors found that aggressive initial electrode coverage was not associated with higher rates of blood transfusion or perioperative complications, and reduced the frequency of repeated operations for placement of supplemental electrodes.
Johnston
James M
JM
Department of Neurosurgery and Division of Pediatric and Developmental Neurology, St. Louis Children's Hospital, Washington University, St. Louis, Missouri 63110, USA. johnstonj@nsurg.wustl.edu
Mangano
Francesco T
FT
Ojemann
Jeffrey G
JG
Park
Tae Sung
TS
Trevathan
Edwin
E
Smyth
Matthew D
MD
D000293:Adolescent; D000328:Adult; D001803:Blood Transfusion / Q000706:statistics & numerical data; D001921:Brain / Q000503:physiopathology / Q000601:surgery; D001931:Brain Mapping; D002648:Child; D002675:Child, Preschool; D004567:Electrodes, Implanted / Q000009:adverse effects*; D004569:Electroencephalography; D004827:Epilepsy / Q000503:physiopathology* / Q000601:surgery*; D005260:Female; D006801:Humans; D015994:Incidence; D007223:Infant; D008297:Male; D008991:Monitoring, Physiologic / Q000295:instrumentation* / Q000379:methods; D009422:Nervous System Diseases / Q000209:etiology / Q000503:physiopathology; D011183:Postoperative Complications / Q000453:epidemiology; D013355:Subdural Space / Q000601:surgery*