Department of Neurosurgery, Georgetown University School of Medicine Washington, D.C., USA.
Department of Neurosurgery, Mount Sinai Hospital System, New York, New York, USA.
World Neurosurg. 2021 Jul;151:e100-e108. doi: 10.1016/j.wneu.2021.03.139. Epub 2021 Apr 2.
OBJECTIVE: Stereoelectroencephalography (sEEG), despite its established usefulness, has not been thoroughly evaluated for its adverse events profile. In this study, hemorrhage rates were evaluated both per patient and per lead placed not only in the immediate postoperative period, but also over the course of admission and after explantation when available. METHODS: This is a single-center retrospective study of pediatric and adult patients undergoing sEEG lead placement at a large urban hospital. All available postoperative imaging was reviewed for the presence of hemorrhage, including any imaging occurring throughout admission as well as within 1 month of lead explantation. Age and number of leads placed per procedure were compared using an unpaired t test assuming unequal variance. RESULTS: A total of 1855 leads were placed in 147 cases. The mean age was 30.4 ±15.0 and the male/female ratio was 47:53. 9 leads (0.49%) in 9 cases (6.12%) were involved with postimplantation hemorrhage occurring on postoperative day 0.44 on average. Postexplantation imaging was available for 45 cases. Seven leads (1.40%) in 7 cases (15.56%) were involved with postexplantation hemorrhage occurring on average on postoperative day 1.42. There was a significant difference in mean age between patients with postexplantation hemorrhage versus control (45.0 vs. 32.2; P = 0.0277). No cases of hemorrhage required surgical intervention and no patients had permanent neurologic deficit. CONCLUSIONS: Hemorrhage after sEEG lead implantation and explantation may be more common than previously reported. Consistent postexplantation imaging may be of clinical benefit in detecting hemorrhage that precludes patients from immediate discharge, particularly in older patients.
目的:尽管立体脑电图(sEEG)已被证实具有一定的应用价值,但尚未对其不良事件谱进行全面评估。本研究不仅评估了即刻术后,还评估了住院期间及在有条件时拔除电极后每个患者和每个电极的出血率。
方法:这是一项在一家大型城市医院进行的单中心回顾性研究,研究对象为接受 sEEG 电极植入的儿科和成年患者。所有可获得的术后影像学资料均用于评估出血情况,包括任何入院期间及电极拔除后 1 个月内的影像学资料。采用非配对 t 检验(假设方差不等)比较每个手术中放置的年龄和电极数量。
结果:共 147 例患者中植入了 1855 个电极。平均年龄为 30.4±15.0 岁,男女比例为 47:53。9 个电极(0.49%)在 9 例患者(6.12%)中出现了术后 0.44 天的植入后出血。45 例患者可获得拔除电极后的影像学资料。7 个电极(1.40%)在 7 例患者(15.56%)中出现了术后 1.42 天的拔除后出血。有和无拔除后出血的患者之间的平均年龄差异有统计学意义(45.0 岁 vs. 32.2 岁;P=0.0277)。无出血病例需要手术干预,也无患者发生永久性神经功能缺损。
结论:sEEG 电极植入和拔除后出血可能比以前报道的更常见。持续的拔除后影像学检查可能对发现导致患者无法立即出院的出血有临床益处,尤其是在老年患者中。
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