Artikel
Implantation of subdural grid electrodes in epilepsy surgery: an operative point of view
Implantation subduraler Gridelektroden zum invasiven Monitoring: perioperative Aspekte
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Autoren
Veröffentlicht: | 4. Mai 2005 |
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Gliederung
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Objective
In epilepsy surgery, invasive monitoring using subdural grid electrodes is performed to determine the epileptogenic zone and define functional brain areas. We evaluated whether there are predictors for possible perioperative complications.
Methods
530 Patients underwent epilepsy-surgery in our department from 1998 to 2004. In 130 Patients (25%), craniotomy for implantation of subdural grid electrodes was performed. The perioperative course from grid implantation to resection procedure and the operative nuances were analysed.
Results
In our series of 130 craniotomies for invasive monitoring, 13 (10%) grid electrodes were removed without resection, because seizure origin was either multilocular or located in functional areas. Operative revision was necessary in 4 cases (3%): Correction of electrode position was performed in two cases. One evacuation of epidural haematoma was necessary without grid removal. One chronic subdural haematoma was operated 2 weeks after grid-implantation. Fixation of grid-electrodes to the dura could not avoid subdural haematoma in 2 cases (1,5%) and led to haematoma under the grid which impaired mapping in 2 other cases (1,5%). These resections were performed with neuronavigation and electrocorticography. In about 10% of the implantations clinical deterioration due to subdural haematoma forced an accelerated mapping and following resection. However, all resections could be carried out as planned. Negative predictors for subdural haematoma in our series are: Re-Craniotomy, Large grid-electrodes (64 or 112 contacts), Electrode-position in the midline.
Conclusions
Implantation of subdural grid electrodes for invasive monitoring leads to surgical resection in 90%. The complication rate is low (6% minor complications, no major complication) and there was no manifest infection, but subdural haematoma could not be avoided in all cases.