title: Delayed intracranial hematoma following stereoelectroencephalography for intractable epilepsy: case report.
abstract: Intracranial bleeding following stereoelectroencephalography (sEEG) is rare and commonly occurs early after electrode implantation. The authors report the case of a delayed intracranial hematoma following sEEG. This 10-year-old boy was referred to the authors' department to undergo an sEEG study for intractable epilepsy, with the hypothesis of a single localized epileptic zone in the left precentral region. To perform the exploration, 14 depth electrodes were implanted under stereotactic conditions. The results of a postoperative CT scan performed routinely at the end of the surgical procedure were normal. Eight days later, following an epileptic seizure, the child's condition worsened. The neurological examination revealed a left hemiparesis, agitation, and coma due to a right subdural hematoma with intraparenchymal bleeding. Despite a surgical evacuation followed by a decompressive craniectomy, the curative treatments were stopped 1 week later due to severe diffuse ischemic lesions found on MRI studies.   This is the first observation of a delayed hematoma following an sEEG procedure. The mechanism underlying this complication remains unclear, but the rupture of a growing pseudoaneurysm caused by the electrode's implantation or the tearing of a neighboring vessel by an electrode were suspected. In consequence, physicians must remain vigilant during the entire sEEG recording period and probably also several days after electrode removal.
authors.affiliation: Department of Neurosurgery, Rouen University Hospital, 1 rue de Germont, Rouen, France. stephane.derrey@chu-rouen.fr
authors.forename: Stéphane
authors.initials: S
authors.lastname: Derrey
authors.forename: Axel
authors.initials: A
authors.lastname: Lebas
authors.forename: Dominique
authors.initials: D
authors.lastname: Parain
authors.forename: Marie Gilles
authors.initials: MG
authors.lastname: Baray
authors.forename: Christophe
authors.initials: C
authors.lastname: Marguet
authors.forename: Pierre
authors.initials: P
authors.lastname: Freger
authors.forename: François
authors.initials: F
authors.lastname: Proust
mesh_terms: D000927:Anticonvulsants; D002545:Brain Ischemia / Q000209:etiology* / Q000473:pathology; D002543:Cerebral Hemorrhage / Q000209:etiology* / Q000503:physiopathology / Q000601:surgery; D002648:Child; D056424:Decompressive Craniectomy; D004351:Drug Resistance; D004567:Electrodes, Implanted / Q000009:adverse effects*; D004569:Electroencephalography / Q000009:adverse effects / Q000295:instrumentation*; D017034:Epilepsy, Frontal Lobe / Q000188:drug therapy / Q000503:physiopathology*; D017809:Fatal Outcome; D006408:Hematoma, Subdural / Q000209:etiology* / Q000503:physiopathology / Q000601:surgery; D006801:Humans; D033183:Interdisciplinary Communication; D019586:Intracranial Hypertension; D008279:Magnetic Resonance Imaging; D008297:Male; D011184:Postoperative Period; D013238:Stereotaxic Techniques; D013997:Time Factors; D014057:Tomography, X-Ray Computed; D028761:Withholding Treatment
chemical_list: D000927:Anticonvulsants