Is postoperative CT scanning predictive of subdural electrode placement complications in pediatric epileptic
Carlo Giussani1, Tanya Filardi, Krishnapundha Bunyaratavej
1Department of Neurological Surgery, Seattle Children's Hospital, University of Washington School of Medicine, Seattle, WA, USA.
Insights
Postoperative CT scans are not reliable for predicting complications after subdural electrode placement in children. Minor midline shifts are common and usually do not indicate serious issues.
Area of Science:
- Neurosurgery
- Pediatric Neurology
- Neuroradiology
Background:
- Subdural electrode implants are used for monitoring intractable seizures in children.
- Assessing the reliability of immediate postoperative CT scans is crucial for predicting complications.
Observation:
- Forty pediatric patients with subdural electrode implants were reviewed.
- Immediate postoperative CT scans were analyzed for hemorrhagic complications and brain swelling causing midline shift.
Findings:
- 65% of patients showed a postoperative midline shift (mean 4.0 mm).
- A midline shift <5 mm did not predict delayed symptomatic complications requiring repeat craniotomy.
- Delayed complications occurred in two patients with initial shifts <5 mm that progressed.
Implications:
- Subdural electrode implantation in children is generally safe.
- Early postoperative midline shifts <5 mm are common and typically not predictive of mass effect complications.
- Complications, when they occur, may manifest later postoperatively.
Aims:
To understand the reliability of postoperative CT scans to predict the development of intracranial hemorrhagic complications associated with subdural electrode implants for monitoring intractable seizure, we reviewed the data of a consecutive series of children treated at our institution.
Methods:
Forty children (mean age: 11.4 years) with subdural electrode implants were reviewed. The immediate postoperative CT scans were evaluated for the presence of hemorrhagic complications and/or brain swelling resulting in a midline shift.
Results:
Twenty-six patients (65%) presented a postoperative midline shift (range = 2-10 mm; mean shift = 4.0 mm). Two children had a midline shift of >5 mm. Two patients with a shift of <5 mm at the first CT scan required a repeat craniotomy. These patients experienced worsening neurologic symptoms in a delayed fashion on postoperative days 1 and 4, respectively. This was correlated to an increase in midline shift of >5 mm.
Conclusions:
Subdural electrode implants in children are safe. The presence of a midline shift of <5 mm is common postoperatively. The presence and extension of the midline shift at the first CT scan does not seem to be predictive of the development of symptomatic complications with a mass effect. Complications happened in a delayed fashion.
