Is postoperative CT scanning predictive of subdural electrode placement complications in pediatric epileptic patients?
OBJECTIVE
To understand the reliability of postoperative CT scans to predict the development of intracranial hemorrhagic complications associated with subdural electrode implants for monitoring intractable seizure, we reviewed the data of a consecutive series of children treated at our institution.


METHODS
Forty children (mean age: 11.4 years) with subdural electrode implants were reviewed. The immediate postoperative CT scans were evaluated for the presence of hemorrhagic complications and/or brain swelling resulting in a midline shift.


RESULTS
Twenty-six patients (65%) presented a postoperative midline shift (range = 2-10 mm; mean shift = 4.0 mm). Two children had a midline shift of >5 mm. Two patients with a shift of <5 mm at the first CT scan required a repeat craniotomy. These patients experienced worsening neurologic symptoms in a delayed fashion on postoperative days 1 and 4, respectively. This was correlated to an increase in midline shift of >5 mm.


CONCLUSIONS
Subdural electrode implants in children are safe. The presence of a midline shift of <5 mm is common postoperatively. The presence and extension of the midline shift at the first CT scan does not seem to be predictive of the development of symptomatic complications with a mass effect. Complications happened in a delayed fashion.
Giussani
Carlo
C
Department of Neurological Surgery, Seattle Children's Hospital, University of Washington School of Medicine, Seattle, WA, USA.
Filardi
Tanya
T
Bunyaratavej
Krishnapundha
K
Mai
Jeffrey C
JC
Ogino
Masahiro
M
Greene
Stephanie
S
Browd
Samuel R
SR
Avellino
Anthony M
AM
Ellenbogen
Richard G
RG
Ojemann
Jeffrey G
JG
D000293:Adolescent; D001929:Brain Edema / Q000000981:diagnostic imaging / Q000209:etiology / Q000601:surgery; D002648:Child; D002675:Child, Preschool; D003399:Craniotomy; D004567:Electrodes, Implanted / Q000009:adverse effects*; D004569:Electroencephalography; D017029:Epilepsy, Complex Partial / Q000175:diagnosis / Q000601:surgery*; D005260:Female; D006408:Hematoma, Subdural / Q000000981:diagnostic imaging / Q000209:etiology* / Q000601:surgery; D006801:Humans; D008297:Male; D008991:Monitoring, Physiologic / Q000009:adverse effects; D011182:Postoperative Care / Q000592:standards; D011237:Predictive Value of Tests; D012086:Reoperation; D015203:Reproducibility of Results; D012189:Retrospective Studies; D014057:Tomography, X-Ray Computed / Q000592:standards*