title: Safety profile of intracranial electrode implantation for video-EEG recordings in drug-resistant focal epilepsy.
abstract: Invasive electroencephalography recordings with depth or subdural electrodes are necessary to identify the ictogenic area in some drug-resistant focal epilepsies. We aimed to analyze the safety profile of intracranial electrode implantation in a tertiary center and the factors associated with its complications. We retrospectively examined complications in 163 intracranial procedures performed in adult patients. Implantation methods included oblique depth stereotactic approach (n = 128) and medial-temporal depth stereotactic approach in combination with subdural strip placement (n = 35). 1201 depth macroelectrodes, 59 bundles of microelectrodes (in 30 patients) and 148 subdural electrodes were implanted. Complications were classified as major (requiring treatment or leading to neurological impairment) or minor. The rate of overall complications was 4.9% (n = 8), with 3.1% (n = 5) of major complications, though no permanent morbidity or mortality was recorded. Infection occurred in 1.2% and hemorrhage in 3.7% of patients. One hemorrhage occurred for every 225 electrodes implanted (4.4‰). Microelectrodes were not responsible for any complications. Overall and hemorrhagic complications were significantly associated with MRI-negative cases (7.3 and 6.3% versus 0%, p = 0.04). We believe that intracranial electrode implantation has a favorable safety profile, without permanent deficit. These risks should be balanced with the benefits of invasive exploration prior to surgery. Furthermore, this study provides preliminary evidence regarding the safety of micro-macroelectrodes.
authors.affiliation: Department of Neurosurgery, La Pitié-Salpêtrière Hospital, AP-HP, Paris, France. bertrand.mathon@neurochirurgie.fr.|Sorbonne University, UPMC, Univ Paris 06, Paris, France. bertrand.mathon@neurochirurgie.fr.
authors.forename: Bertrand
authors.initials: B
authors.lastname: Mathon
authors.affiliation: Department of Neurosurgery, La Pitié-Salpêtrière Hospital, AP-HP, Paris, France.
authors.forename: Stéphane
authors.initials: S
authors.lastname: Clemenceau
authors.affiliation: Department of Neuroradiology, La Pitié-Salpêtrière Hospital, AP-HP, Paris, France.|Sorbonne University, UPMC, Univ Paris 06, Paris, France.
authors.forename: Dominique
authors.initials: D
authors.lastname: Hasboun
authors.affiliation: Department of Nuclear Medicine, La Pitié-Salpêtrière Hospital, AP-HP, Paris, France.|Sorbonne University, UPMC, Univ Paris 06, Paris, France.
authors.forename: Marie-Odile
authors.initials: MO
authors.lastname: Habert
authors.affiliation: Department of Neurosurgery, La Pitié-Salpêtrière Hospital, AP-HP, Paris, France.|Brain and Spine Institute (CRICM-ICM; INSERM, UMRS 1127; CNRS, UMR 7225), Paris, France.
authors.forename: Hayat
authors.initials: H
authors.lastname: Belaid
authors.affiliation: Department of Neurology, Epileptology Unit, La Pitié-Salpêtrière Hospital, AP-HP, Paris, France.
authors.forename: Vi-Huong
authors.initials: VH
authors.lastname: Nguyen-Michel
authors.affiliation: Department of Neurology, Epileptology Unit, La Pitié-Salpêtrière Hospital, AP-HP, Paris, France.|Brain and Spine Institute (CRICM-ICM; INSERM, UMRS 1127; CNRS, UMR 7225), Paris, France.
authors.forename: Virginie
authors.initials: V
authors.lastname: Lambrecq
authors.affiliation: Department of Neurology, Epileptology Unit, La Pitié-Salpêtrière Hospital, AP-HP, Paris, France.|Brain and Spine Institute (CRICM-ICM; INSERM, UMRS 1127; CNRS, UMR 7225), Paris, France.|Sorbonne University, UPMC, Univ Paris 06, Paris, France.
authors.forename: Vincent
authors.initials: V
authors.lastname: Navarro
authors.affiliation: Department of Neurology, Epileptology Unit, La Pitié-Salpêtrière Hospital, AP-HP, Paris, France.|Department of Rehabilitation, La Pitié-Salpêtrière Hospital, AP-HP, Paris, France.|Brain and Spine Institute (CRICM-ICM; INSERM, UMRS 1127; CNRS, UMR 7225), Paris, France.|Sorbonne University, UPMC, Univ Paris 06, Paris, France.
authors.forename: Sophie
authors.initials: S
authors.lastname: Dupont
authors.affiliation: Department of Neurology, Epileptology Unit, La Pitié-Salpêtrière Hospital, AP-HP, Paris, France.|Brain and Spine Institute (CRICM-ICM; INSERM, UMRS 1127; CNRS, UMR 7225), Paris, France.|Sorbonne University, UPMC, Univ Paris 06, Paris, France.
authors.forename: Michel
authors.initials: M
authors.lastname: Baulac
authors.affiliation: Department of Neurosurgery, La Pitié-Salpêtrière Hospital, AP-HP, Paris, France.|Sorbonne University, UPMC, Univ Paris 06, Paris, France.
authors.forename: Philippe
authors.initials: P
authors.lastname: Cornu
authors.affiliation: Department of Neurology, Epileptology Unit, La Pitié-Salpêtrière Hospital, AP-HP, Paris, France.|Brain and Spine Institute (CRICM-ICM; INSERM, UMRS 1127; CNRS, UMR 7225), Paris, France.
authors.forename: Claude
authors.initials: C
authors.lastname: Adam
mesh_terms: D000293:Adolescent; D000328:Adult; D000069279:Drug Resistant Epilepsy / Q000175:diagnosis*; D004567:Electrodes, Implanted / Q000009:adverse effects* / Q000706:statistics & numerical data; D004569:Electroencephalography / Q000009:adverse effects* / Q000706:statistics & numerical data; D004828:Epilepsies, Partial / Q000175:diagnosis*; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D019635:Neurosurgical Procedures / Q000009:adverse effects* / Q000706:statistics & numerical data; D011183:Postoperative Complications / Q000453:epidemiology; D055815:Young Adult
keywords: Adverse events; Complications; Depth electrodes; Epilepsy surgery; Invasive EEG; SEEG (Stereoelectroencephalography)