title: Optimizations and Nuances in Neurosurgical Technique for the Minimization of Complications in Subdural Electrode Placement for Epilepsy Surgery.
abstract: BACKGROUND
  Surgical intervention is an important therapeutic option for patients with intractable epilepsy and a well-characterized epileptogenic focus. Invasive monitoring with subdural electrodes is an effective technique for localizing epileptogenic foci. Previous studies reported varying complication rates, and these may deter more widespread adoption. We present potentially valuable technical nuances that may be associated with low complication rates. We assess the potential contribution of specific aspects of surgical technique to the reduction of complication rates.
  
  
  METHODS
  We retrospectively reviewed patients from the Rush University Surgical Epilepsy database who underwent craniotomies for invasive electroencephalography monitoring for medically intractable epilepsy using our technique. We analyzed and compared complication rates and techniques with those reported elsewhere.
  
  
  RESULTS
  The sample group comprised 127 consecutive patients who underwent electrode implantation. The average monitoring period was 6 days. There were 5 complications (3.9%), including 1 subdural hematoma requiring surgery (0.8%), 1 infection (0.8%), 2 pulmonary emboli (1.6%), and 1 deep vein thrombosis (0.8%). There were no symptomatic cerebrospinal fluid leaks or permanent neurologic complications. These results compare favorably with published results. Analysis and comparison of our technique anecdotally suggest the importance of use of a subgaleal drain throughout the monitoring period, postoperative antibiotic coverage for 1 week, meticulous hemostasis, and secure suturing of the electrodes to the dura mater to minimize trauma to superficial vessels as potential contributors to improved complication rates.
  
  
  CONCLUSIONS
  A very low incidence of major morbidity can be achieved in invasive electroencephalography monitoring with this protocol.
authors: Department of Neurosurgery, Rush University Medical Center, Chicago, Illinois, USA; St. Luke's Neurosurgical Associates, Bethlehem, Pennsylvania, USA.
authors: Steven M
authors: SM
authors: Falowski
authors: Department of Neurosurgery, Rush University Medical Center, Chicago, Illinois, USA. Electronic address: djdilore@alum.mit.edu.
authors: Daniel J
authors: DJ
authors: DiLorenzo
authors: Department of Neurosurgery, Rush University Medical Center, Chicago, Illinois, USA; Mid-Atlantic Neurosurgical Associates, Baltimore, Maryland, USA.
authors: Larry R
authors: LR
authors: Shannon
authors: Department of Neurosurgery, Rush University Medical Center, Chicago, Illinois, USA.
authors: David J
authors: DJ
authors: Wallace
authors: Rush Medical College, Chicago, Illinois, USA; Department of Emergency Medicine, University of Cincinnati, Cincinnati, Ohio, USA.
authors: James
authors: J
authors: Devries
authors: Department of Neurosurgery, Rush University Medical Center, Chicago, Illinois, USA.
authors: Robert G
authors: RG
authors: Kellogg
authors: Department of Neurosurgery, Rush University Medical Center, Chicago, Illinois, USA.
authors: Nicholas P
authors: NP
authors: Cozzi
authors: Department of Nursing, Rush University Medical Center, Chicago, Illinois, USA.
authors: Lou F
authors: LF
authors: Fogg
authors: Department of Neurosurgery, Rush University Medical Center, Chicago, Illinois, USA.
authors: Richard W
authors: RW
authors: Byrne
mesh_terms: D000293:Adolescent; D000328:Adult; D002648:Child; D002675:Child, Preschool; D003399:Craniotomy; D004322:Drainage; D004567:Electrodes, Implanted / Q000009:adverse effects*; D004569:Electroencephalography; D004827:Epilepsy / Q000601:surgery*; D005260:Female; D006801:Humans; D007427:Intracranial Pressure; D064795:Intraoperative Neurophysiological Monitoring; D008297:Male; D008875:Middle Aged; D019635:Neurosurgical Procedures / Q000009:adverse effects* / Q000379:methods*; D011183:Postoperative Complications / Q000453:epidemiology / Q000517:prevention & control*; D019106:Postoperative Hemorrhage / Q000453:epidemiology; D012189:Retrospective Studies; D013355:Subdural Space / Q000601:surgery*; D013530:Surgical Wound Infection / Q000453:epidemiology; D055815:Young Adult
keywords: Complications; Depth electrode; Electrodes; Epilepsy; Epilepsy surgery; Implanted electrodes; Intracranial EEG; Invasive EEG; Subdural electrodes; Surgical closure technique