Freiburg Epilepsy Center, Medical Center - University of Freiburg, Faculty of Medicine, University of Freiburg, Breisacher Str. 64, Freiburg im Breisgau 79106, Germany.
Freiburg Epilepsy Center, Medical Center - University of Freiburg, Faculty of Medicine, University of Freiburg, Breisacher Str. 64, Freiburg im Breisgau 79106, Germany; Member of the European Reference Network for Rare and Complex Epilepsies EpiCARE, Germany.
Seizure. 2023 Aug;110:21-27. doi: 10.1016/j.seizure.2023.05.022. Epub 2023 Jun 3.
To analyze the safety profile of subdural and depth electrode implantation in a large monocentric cohort of patients of all ages undergoing intracranial EEG exploration because of drug resistant focal epilepsy diagnosed and implanted by a constant team of epileptologists and neurosurgeons.
We retrospectively analyzed data from 452 implantations in 420 patients undergoing invasive presurgical evaluation at the Freiburg Epilepsy Center from 1999 to 2019 (n = 160 subdural electrodes, n = 156 depth electrodes and n = 136 combination of both approaches). Complications were classified as hemorrhage with or without clinical manifestations, infection-associated and other complications. Furthermore, possible risk factors (age, duration of invasive monitoring, number of electrode contacts used) and changes in complication rates during the study period were analyzed.
The most frequent complications in both implantation groups were hemorrhages. Subdural electrode explorations caused significantly more symptomatic hemorrhages and required more operative interventions (SDE 9.9%, DE 0.3%, p < 0.05). Hemorrhage risk was higher for grids with 64 contacts than for smaller grids (p < 0.05). The infection rate was very low (0,2%). A transient neurological deficit occurred in 8.8% of all implantations and persisted for at least 3 months in 1.3%. Transient, but not persistent neurological deficits were more common in patients with implanted subdural electrodes than in the depth electrode group.
The use of subdural electrodes was associated with a higher risk of hemorrhage and transient neurological symptoms. However persistent deficits were rare with either approach, demonstrating that intracranial investigations using either subdural electrodes or depth electrodes carry acceptable risks in patients with drug-resistant focal epilepsy.
分析在一个由癫痫专家和神经外科医生组成的固定团队诊断和植入的所有年龄段的耐药性局灶性癫痫患者中，进行颅内脑电图（EEG）探测的大的单中心队列中，行硬膜下和深部电极植入的安全性概况。
我们回顾性分析了 1999 年至 2019 年期间在弗莱堡癫痫中心接受侵袭性术前评估的 420 名患者（n=160 个硬膜下电极，n=156 个深部电极和 n=136 个联合使用这两种方法）的 452 次植入的资料。并发症分为伴有或不伴有临床表现的出血、感染相关和其他并发症。此外，分析了研究期间可能的危险因素（年龄、侵袭性监测持续时间、使用的电极接触数）和并发症发生率的变化。
两种植入组最常见的并发症均为出血。硬膜下电极探查引起的症状性出血和需要更多手术干预的情况明显更多（SDE 9.9%，DE 0.3%，p<0.05）。具有 64 个接触点的网格出血风险高于较小的网格（p<0.05）。感染率非常低（0.2%）。所有植入物中，8.8%出现短暂性神经功能缺损，1.3%至少持续 3 个月。暂时性但非持续性神经功能缺损在植入硬膜下电极的患者中比深部电极组更常见。
使用硬膜下电极与出血和短暂性神经症状的风险增加相关。然而，两种方法都很少出现持续性缺陷，这表明在耐药性局灶性癫痫患者中，使用硬膜下电极或深部电极进行颅内检查的风险是可以接受的。
