Intracranial Electrode Placement for Seizures Before Temporal Lobectomy: A Risk-Benefit Analysis

Anterior 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.

Data 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.

Patients 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%).

Intracranial 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.