Stereoelectroencephalography Versus Subdural Strip Electrode Implantations: Feasibility, Complications, and Outcomes in 500 Intracranial Monitoring Cases for Drug-Resistant Epilepsy

Abstract

BACKGROUND: Both stereoelectroencephalography (SEEG) and subdural strip electrodes (SSE) are used for intracranial electroencephalographic recordings in the invasive investigation of patients with drug-resistant epilepsy. OBJECTIVE: To compare SEEG and SSE with respect to feasibility, complications, and outcome in this single-center study. METHODS: Patient characteristics, periprocedural parameters, complications, and outcome were acquired from a pro- and retrospectively managed databank to compare SEEG and SSE cases. RESULTS: A total of 500 intracranial electroencephalographic monitoring cases in 450 patients were analyzed (145 SEEG and 355 SSE). Both groups were of similar age, gender distribution, and duration of epilepsy. Implantation of each SEEG electrode took 13.9 7.6 min (20 +/- 12 min for each SSE; P < .01). Radiation exposure to the patient was 4.3 +/- 7.7 s to a dose area product of 14.6 +/- 27.9 rad*cm(2) for SEEG and 9.4 +/- 8.9 s with 21 +/- 22.4 rad*cm(2) for SSE (P < .01). There was no difference in the length of stay (12.2 +/- 7.2 and 12 +/- 6.3 d). The complication rate was low in both groups. No infections were seen in SEEG cases (2.3% after SSE). The rate of hemorrhage was 2.8% for SEEG and 1.4% for SSE. Surgical outcome was similar. CONCLUSION: SEEG allows targeting deeply situated foci with a non-inferior safety profile to SSE and seizure outcome comparable to SSE.