title: Reduced complications from intracranial grid insertion by using a small grid size and a precise protocol during monitoring.
abstract: BACKGROUND
  A study of the risk factors associated with complications during intracranial EEG monitoring led to a change in protocol for monitoring and implantation at our centres. We conducted a study to identify any reduction in complications following the changed protocols involving the use of smaller subdural electrode arrays, continuous ICP monitoring, use of a central line, and intake of prophylactic antibiotics and dexamethasone.
  
  
  METHODS
  We prospectively collected data on patient outcomes between 2005 and 2012 (group B) compared with patients between 1988 and 2004 (group A) before the protocol changes.
  
  
  RESULTS
  Seventy-one patients in group A and 58 patients in group B underwent intracranial electrode implantation. Complications directly related to grids occurred in 25 % of group A vs. 8.6 % in group B (p < 0.05) and those indirectly related to grids were 11.2 % in group A vs. none in group B. The rate of transient complications requiring no treatment was 12.5 % in group A versus 1.7 % in group B. The rate of transient complications requiring treatment was 10 % in group A and 6.9 % in group B. There were two deaths in group A. The infection rate was higher in group B than group A (5.2 % vs. 2.8 %; p = 0.90). Since 2008 there have been no infective complications. Complications directly related to intracranial EEG monitoring were significantly reduced using the revised protocol (p < 0.05). Regression analysis identifying only the size of the grids (≤4 × 8 grid arrays) implanted was an independent predictor of more complications in group A (P < 0.05).
  
  
  CONCLUSIONS
  Complication rates following intracranial implantation decreased following the use of a small grid size and adherence to a stringent protocol.
authors.affiliation: Westmead Hospital, Darcy Road, Westmead, NSW, 2145, Australia. zebun97@hotmail.com.
authors.forename: Zebunnessa
authors.identifier: http://orcid.org/0000-0002-6375-6804
authors.initials: Z
authors.lastname: Rahman
authors.affiliation: Westmead Hospital, Darcy Road, Westmead, NSW, 2145, Australia.|The Children's Hospital at Westmead, Hawkesbury Road, Westmead, 2145, Australia.
authors.forename: Andrew F
authors.initials: AF
authors.lastname: Bleasel
authors.affiliation: Westmead Hospital, Darcy Road, Westmead, NSW, 2145, Australia.
authors.forename: Melissa
authors.initials: M
authors.lastname: Bartley
authors.affiliation: Westmead Hospital, Darcy Road, Westmead, NSW, 2145, Australia.|The Children's Hospital at Westmead, Hawkesbury Road, Westmead, 2145, Australia.
authors.forename: Mark
authors.initials: M
authors.lastname: Dexter
authors.affiliation: The Children's Hospital at Westmead, Hawkesbury Road, Westmead, 2145, Australia.
authors.forename: Tony
authors.initials: T
authors.lastname: Galea
authors.affiliation: The Children's Hospital at Westmead, Hawkesbury Road, Westmead, 2145, Australia.
authors.forename: Deepak
authors.initials: D
authors.lastname: Gill
authors.affiliation: The Children's Hospital at Westmead, Hawkesbury Road, Westmead, 2145, Australia.
authors.forename: Samantha
authors.initials: S
authors.lastname: Soe
authors.affiliation: Westmead Hospital, Darcy Road, Westmead, NSW, 2145, Australia.
authors.forename: Karen
authors.initials: K
authors.lastname: Byth
authors.affiliation: Westmead Hospital, Darcy Road, Westmead, NSW, 2145, Australia.|The Children's Hospital at Westmead, Hawkesbury Road, Westmead, 2145, Australia.
authors.forename: Chong H
authors.initials: CH
authors.lastname: Wong
mesh_terms: D000328:Adult; D004567:Electrodes, Implanted / Q000009:adverse effects*; D004569:Electroencephalography / Q000009:adverse effects* / Q000295:instrumentation / Q000379:methods; D005260:Female; D006801:Humans; D007427:Intracranial Pressure; D008297:Male; D008875:Middle Aged
keywords: Electroencephalography; Epilepsy; Postoperative complication; Protocol; Risk factors; Subdural