Johnston James M, Mangano Francesco T, Ojemann Jeffrey G, Park Tae Sung, Trevathan Edwin, Smyth Matthew D
Department of Neurosurgery and Division of Pediatric and Developmental Neurology, St. Louis Children's Hospital, Washington University, St. Louis, Missouri 63110, USA.
J Neurosurg. 2006 Nov;105(5 Suppl):343-7. doi: 10.3171/ped.2006.105.5.343.
The purpose of this study was to better define the incidence of complications associated with placement of subdural electrodes for localization of seizure foci and functional mapping in children.
The authors retrospectively reviewed the records of 112 consecutive patients (53 boys, 59 girls; mean age 10.9 years, range 10 months-21.7 years) with medically intractable epilepsy who underwent invasive monitoring at the Pediatric Epilepsy Center at St. Louis Children's Hospital between January 1994 and July 2005. There were 122 implantation procedures (85 grids and strips, 32 strips only, five grids only, four with additional depth electrodes), with a mean monitoring period of 7.1 days (range 2-21 days). Operative complications included the need for repeated surgery for additional electrode placement (5.7%); wound infection (2.4%); cerebrospinal fluid leak (1.6%); and subdural hematoma, symptomatic pneumocephalus, bone flap osteomyelitis, and strip electrode fracture requiring operative retrieval (one patient [0.8%] each). There were four cases of transient neurological deficit (3.3%) and no permanent deficit or death associated with invasive monitoring.
Placement of subdural grid and strip electrodes for invasive video electroencephalographic monitoring is generally well tolerated in the pediatric population. The authors found that aggressive initial electrode coverage was not associated with higher rates of blood transfusion or perioperative complications, and reduced the frequency of repeated operations for placement of supplemental electrodes.
本研究旨在更准确地确定与儿童癫痫病灶定位及功能图谱绘制时硬膜下电极置入相关并发症的发生率。
作者回顾性分析了1994年1月至2005年7月期间在圣路易斯儿童医院儿科癫痫中心接受侵入性监测的112例连续患者（53例男孩，59例女孩；平均年龄10.9岁，范围10个月至21.7岁）的病历，这些患者均患有药物难治性癫痫。共进行了122次植入手术（85次使用网格和条状电极，32次仅使用条状电极，5次仅使用网格电极，4次使用了额外的深部电极），平均监测期为7.1天（范围2至21天）。手术并发症包括因需要额外放置电极而进行再次手术（5.7%）；伤口感染（2.4%）；脑脊液漏（1.6%）；以及硬膜下血肿、有症状的气颅、骨瓣骨髓炎和需要手术取出的条状电极骨折（各1例患者[0.8%]）。有4例出现短暂性神经功能缺损（3.3%），且侵入性监测未导致永久性神经功能缺损或死亡。
在儿科患者中，硬膜下网格和条状电极用于侵入性视频脑电图监测一般耐受性良好。作者发现，初始电极覆盖范围广与输血率或围手术期并发症发生率较高无关，且减少了补充电极放置的再次手术频率。
