Delayed hemorrhage after pediatric stereo-electroencephalography: delayed occurrence or delayed diagnosis?

Area of Science:

• Neurosurgery
• Epileptology
• Diagnostic Imaging

Background:

• Stereo-electroencephalography (SEEG) is a key invasive diagnostic tool for drug-resistant epilepsy (DRE).
• Intracranial hemorrhage (ICH) is the most significant complication of SEEG, though generally low.
• Delayed intracranial hemorrhages (DIH) can occur post-SEEG, even with negative immediate postoperative imaging.

Purpose of the Study:

• To investigate the incidence and characteristics of delayed intracranial hemorrhages (DIH) following SEEG in pediatric patients.
• To evaluate the effectiveness of immediate versus delayed imaging in detecting SEEG-related hemorrhages.

Main Methods:

• Retrospective review of 25 pediatric patients with DRE undergoing SEEG between April 2016 and December 2020.
• Immediate postoperative CT scans and 24-hour post-surgery MRI scans were analyzed.
• Hemorrhages were classified as major or minor based on Wellmer's classification.

Main Results:

• Three intracranial hemorrhages (ICH) were identified among 25 patients (12% risk per procedure).
• Two ICHs were asymptomatic, while one required surgical intervention.
• Two hemorrhages were not detected on immediate CT but were incidentally found on the 24-hour MRI, classified as DIH.

Conclusions:

• Delayed intracranial hemorrhages (DIH) after SEEG are an underreported complication.
• The findings suggest that immediate postoperative imaging may miss some hemorrhages.
• Routine late postoperative imaging (e.g., 24-hour MRI) is recommended for accurate diagnosis and management of DIH.