Rahman Zebunnessa, Bleasel Andrew F, Bartley Melissa, Dexter Mark, Galea Tony, Gill Deepak, Soe Samantha, Byth Karen, Wong Chong H
Westmead Hospital, Darcy Road, Westmead, NSW, 2145, Australia.
The Children's Hospital at Westmead, Hawkesbury Road, Westmead, 2145, Australia.
Acta Neurochir (Wien). 2016 Feb;158(2):395-403; discussion 402-3. doi: 10.1007/s00701-015-2647-6. Epub 2015 Dec 9.
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.
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.
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).
Complication rates following intracranial implantation decreased following the use of a small grid size and adherence to a stringent protocol.
一项关于颅内脑电图监测期间并发症相关危险因素的研究促使我们中心的监测和植入方案发生了改变。我们开展了一项研究，以确定在采用了使用更小的硬膜下电极阵列、连续颅内压监测、使用中心静脉导管以及预防性使用抗生素和地塞米松的改变后的方案后，并发症是否有所减少。
我们前瞻性地收集了2005年至2012年期间患者的结局数据（B组），并与方案改变前1988年至2004年期间的患者（A组）进行比较。
A组71例患者和B组58例患者接受了颅内电极植入。与电极格直接相关的并发症在A组中为25%，而在B组中为8.6%（p<0.05）；与电极格间接相关的并发症在A组中为11.2%，而在B组中无。无需治疗的短暂性并发症发生率在A组中为12.5%，在B组中为1.7%。需要治疗的短暂性并发症发生率在A组中为10%，在B组中为6.9%。A组有2例死亡。B组的感染率高于A组（5.2%对2.8%；p = 0.90）。自2008年以来未出现感染性并发症。使用修订后的方案，与颅内脑电图监测直接相关的并发症显著减少（p<0.05）。回归分析表明，仅植入的电极格大小（≤4×8电极格阵列）是A组更多并发症的独立预测因素（P<0.05）。
采用小电极格尺寸并严格遵守方案后，颅内植入后的并发症发生率降低。
