1Case Western Reserve University School of Medicine, Cleveland.
2Department of Neurosurgery, Cleveland Clinic, Cleveland; and.
J Neurosurg Pediatr. 2023 Aug 11;32(5):562-568. doi: 10.3171/2023.6.PEDS2351. Print 2023 Nov 1.
One consideration in pediatric stereoencephalography (SEEG) is decreased skull thicknesses compared with adults, which may limit traditional bolt-based anchoring of electrodes. The authors aimed to investigate the safety profile, complication rates, and technical adaptations of placing SEEG electrodes in pediatric patients.
The authors retrospectively reviewed all patients aged 12 years or younger at the time of SEEG implantation at their institution. Postimplantation CT scans were used to measure skull thickness at the entry point of each SEEG lead. Postimplantation lead accuracy was also assessed.
Fifty-three patients were reviewed. The median skull thickness was 4.1 (interquartile range [IQR] 3.15-5.2) mm. There were 5 total complications: 1 retained bolt fragment, 3 asymptomatic subdural hematomas, and 1 asymptomatic intracranial hemorrhage. Median radial error from the lead target was 3.5 (IQR 2.24-5.25) mm. Linear regression analysis revealed that increasing skull thickness decreased the deviation from the intended target, implying an improved accuracy to target at thicker skull entry points; this trended towards improved accuracy, but did not achieve statistical significance (p = 0.54).
This study found a 1.9% hardware complication rate and a 9.4% asymptomatic hemorrhage rate. Suturing electrodes to the scalp may represent a reasonable option if there are concerns of young age or a thin skull. These data indicate that invasive SEEG evaluation is safe among patients 12 years old or younger.
与成年人相比，儿童的颅骨厚度较薄，这在进行立体定向脑电图（SEEG）时需要考虑，可能会限制传统基于螺栓的电极固定。作者旨在研究在儿科患者中放置 SEEG 电极的安全性概况、并发症发生率和技术适应性。
作者回顾性分析了他们机构中所有在进行 SEEG 植入时年龄为 12 岁或以下的患者。使用术后 CT 扫描测量每个 SEEG 导联入口处的颅骨厚度。还评估了术后导联的准确性。
共回顾了 53 例患者。颅骨厚度中位数为 4.1（四分位距 [IQR] 3.15-5.2）mm。共有 5 例总并发症：1 例残留螺栓碎片，3 例无症状硬膜下血肿和 1 例无症状颅内出血。从导联目标的径向误差中位数为 3.5（IQR 2.24-5.25）mm。线性回归分析表明，颅骨厚度增加会减少与目标的偏差，这意味着在颅骨入口较厚的情况下，准确性会提高；这表明准确性有所提高，但未达到统计学意义（p = 0.54）。
本研究发现硬件并发症发生率为 1.9%，无症状出血发生率为 9.4%。如果存在对年龄较小或颅骨较薄的担忧，将电极缝合到头皮上可能是一个合理的选择。这些数据表明，12 岁或以下的患者进行有创性 SEEG 评估是安全的。
