Epilepsy Center, Neurological Institute, Cleveland Clinic, Cleveland, Ohio.
Department of Neurosurgery, University of Minnesota, Minneapolis, Minnesota.
Epilepsia. 2019 Mar;60(3):571-580. doi: 10.1111/epi.14668. Epub 2019 Feb 12.
To examine the true incidence of hemorrhage related to stereo-electroencephalography (SEEG) procedures. To analyze risk factors associated with the presence of different types of hemorrhage in SEEG procedures.
This was a retrospective, single-center observational study examining every SEEG implantation performed at our center from 2009 to 2017. This consisted of 549 consecutive SEEG implantations using a variety of stereotactic and imaging techniques. A hemorrhage grading system was applied by a blinded neuroradiologist to every postimplant and postexplant computed tomography (CT) scan. Hemorrhages were classified as asymptomatic or symptomatic based on neurologic deficit seen on examination. Statistical analysis included multivariate regression using relevant preoperative variables to predict the presence of hemorrhage.
One hundred five implantations (19.1%) had any type of hemorrhage seen on postimplant CT. Of these, 93 (16.9%) were asymptomatic and 12 (2.2%) were symptomatic, with 3 implantations (0.6%) resulting in either a permanent deficit (2, 0.4%) or death (1, 0.2%). Male sex, increased number of electrodes, and increasing age were associated with increased risk of postimplant hemorrhage on multivariate analysis. Increasing score in the grading system was related to a statistically significant increase in the likelihood of a symptomatic hemorrhage.
Detailed examination of every postimplant CT reveals that the total hemorrhage rate appears higher than previously reported. Most of these hemorrhages are small and asymptomatic. Our grading system may be useful to risk stratify these hemorrhages and awaits prospective validation.
研究立体定向脑电图（SEEG）手术相关出血的真实发生率。分析与 SEEG 手术中不同类型出血相关的危险因素。
这是一项回顾性、单中心观察性研究，对 2009 年至 2017 年期间在我中心进行的每例 SEEG 植入术进行了检查。这包括 549 例连续的使用各种立体定向和成像技术进行的 SEEG 植入术。一名神经放射科医生对每例术后和术后 CT 扫描应用了出血分级系统。根据检查中出现的神经功能缺损，将出血分为无症状或有症状。统计分析包括使用相关术前变量进行多变量回归，以预测出血的存在。
105 例（19.1%）的术后 CT 可见任何类型的出血。其中，93 例（16.9%）为无症状，12 例（2.2%）为有症状，3 例（0.6%）导致永久性缺损（2 例，0.4%）或死亡（1 例，0.2%）。多变量分析显示，男性、电极数量增加和年龄增加与术后出血风险增加相关。分级系统评分的增加与有症状出血的可能性增加呈统计学相关。
对每例术后 CT 的详细检查显示，总出血率似乎高于先前报道。这些出血大多较小且无症状。我们的分级系统可能有助于对这些出血进行风险分层，有待前瞻性验证。
