• World Neurosurg · Jan 2019

    Intracranial electrode placement prior to temporal lobectomy for seizures: a risk-benefit analysis.

    • Abhiraj D Bhimani, Ashley N Selner, Darian R Esfahani, Ryan G Chiu, Clayton L Rosinski, David Rosenberg, Andrew Mudreac, Ryne J Diamond, Zayed Almadidy, and Ankit I Mehta.
    • Department of Neurosurgery, University of Illinois at Chicago, Chicago, Illinois, USA.
    • World Neurosurg. 2019 Jan 1; 121: e215-e222.

    Background And ObjectiveAnterior temporal lobectomy (ATL) is the most common surgical procedure for refractory temporal lobe epilepsy. When scalp electroencephalography cannot adequately identify an epileptogenic site, electrode implantation may be used to monitor epileptic activity and localize a target focus before surgical resection. Whether the advantage of improved seizure localization justifies the added risk of electrode placement remains unclear. : The present study uses an international surgical database to explore whether a 2wo-stage approach, electrode implant followed by ATL, has a reasonable safety profile and is clinically worthwhile versus ATL alone.MethodsData from the American College of Surgeons National Surgical Quality Improvement Program for 2005 to 2016 were queried to identify patients undergoing ATL or electrode implant for epilepsy. The 30-day postoperative outcomes were analyzed for the electrode implant and ATL groups, and individual and combined risk profiles were determined.ResultsPatients undergoing electrode implant followed by ATL had a predicted reoperation rate of 7.6%, readmission rate of 14.6%, and a 30-day mortality rate of 1.2%. The combined rate of patients having ≥1 medical complication for 2-staged procedures was higher, at 14.7%. The most common complications encountered were urinary tract infection (2.7%) and sepsis (2.7%).ConclusionsIntracranial electrode placement increases the risk of complications when added to ATL. The severity of complications from electrode placement are mild, however, and as intracranial electrode recording provides a potentially large reduction in the surgical failure risk, electrode placement may be advisable for all but the most convincing seizure foci.Copyright © 2018 Elsevier Inc. All rights reserved.

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