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Placement of subdural grids in pediatric patients: technique and results
William E Bingaman1, Juan Bulacio
1Department of Neurosurgery, Cleveland Clinic, Neurological Institute, 9500 Euclid Avenue, Desk S60, Cleveland, OH, 44195, USA, bingamb@ccf.org.
Insights
This study details using chronic invasive electrodes for pediatric epilepsy. These electrodes help pinpoint the seizure focus in difficult cases, improving surgical outcomes.
Area of Science:
- Neurology
- Neurosurgery
- Epileptology
Background:
- Medically intractable epilepsy in children poses significant management challenges.
- Identifying the epileptogenic zone is crucial for successful surgical intervention.
- Chronic invasive electrode placement offers a method for detailed seizure focus localization.
Purpose of the Study:
- To outline the indications for using chronic invasive electrodes in pediatric epilepsy.
- To describe the techniques involved in applying these electrodes in pediatric patients.
- To enhance the understanding of invasive monitoring for intractable childhood epilepsy.
Main Methods:
- Retrospective literature review.
- Analysis of personal experience from a high-volume tertiary epilepsy center.
- Focus on pediatric patients with medically refractory epilepsy.
Main Results:
- Chronic invasive subdural recordings are safe and effective for identifying the epileptogenic zone (EZ).
- Localization accuracy of the EZ approaches 90-100% in selected pediatric epilepsy cases.
- Seizure-free outcomes are influenced by surgical team expertise and resection extent.
Conclusions:
- Invasive subdural monitoring is a valuable tool in pediatric epilepsy surgery.
- Accurate EZ localization is achievable, but seizure freedom depends on surgical factors.
- This technique aids in understanding the relationship between the EZ and functional cortex.
Purpose:
The purpose of this study is to describe common indications and technique for the application of chronic invasive electrodes in the pediatric patient suffering from medically intractable epilepsy.
Methods:
This chapter was prepared based on a retrospective review of the literature and personal experience based from a large tertiary epilepsy center.
Conclusions:
Invasive subdural recordings are a safe and efficacious tool to identify the epileptogenic zone and its relationship to functional cortex in highly selected patients with medically refractory epilepsy. The ability to localize the EZ approaches 90 to 100 %, but seizure-free outcome is more complex depending greatly on the experience of the surgical team and the extent of resection.
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