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Updated: Oct 21, 2025
Stereo-Electro-Encephalo-Graphy SEEG With Robotic Assistance in the Presurgical Evaluation of Medical Refractory Epilepsy: A Technical Note
Published on: June 13, 2016
Early implementation of stereoelectroencephalography in children: a multiinstitutional case series
Jacob R Lepard1, Irene Kim2, Anastasia Arynchyna1
11Department of Neurological Surgery, University of Alabama at Birmingham, Alabama.
Insights
This multicenter study of pediatric stereoelectroencephalography (SEEG) found that 47.1% of patients were seizure-free after surgery, with a low complication rate. This establishes practice patterns for this epilepsy treatment.
Area of Science:
- Pediatric Neurology
- Neurosurgery
- Epileptology
Background:
- Pediatric stereoelectroencephalography (SEEG) is increasingly utilized for epilepsy diagnosis and treatment.
- Published literature on pediatric SEEG is predominantly from single-center studies, limiting generalizability.
- Multicenter data is needed to establish normative practices and outcomes for pediatric SEEG.
Purpose of the Study:
- To evaluate the multicenter experience with pediatric stereoelectroencephalography (SEEG).
- To analyze patient demographics, surgical outcomes, and complication rates across multiple pediatric epilepsy centers.
- To establish practice patterns and provide a framework for patient selection in pediatric SEEG.
Main Methods:
- Retrospective cohort study adhering to STROBE criteria.
- Inclusion of 170 SEEG procedures from 6 level 4 pediatric epilepsy centers.
- Statistical analysis using ANOVA for continuous variables and logistic regression for dichotomous outcomes.
Main Results:
- The mean age of patients undergoing SEEG was 12.3 years.
- Epileptogenic loci were identified in 84.7% of cases.
- Postoperative seizure freedom was achieved in 47.1% of patients who underwent surgery, with a 5.3% hemorrhage rate and no mortalities.
Conclusions:
- This is the first multicenter case series on pediatric SEEG, establishing normative practice patterns.
- The findings provide a generalizable framework for anticipated outcomes and patient selection.
- The study facilitates discussion on acceptable complication rates for pediatric SEEG.
Objective:
Pediatric stereoelectroencephalography (SEEG) has been increasingly performed in the United States, with published literature being limited primarily to large single-center case series. The purpose of this study was to evaluate the experience of pediatric epilepsy centers, where the technique has been adopted in the last several years, via a multicenter case series studying patient demographics, outcomes, and complications.
Methods:
A retrospective cohort methodology was used based on the STROBE criteria. ANOVA was used to evaluate for significant differences between the means of continuous variables among centers. Dichotomous outcomes were assessed between centers using a univariate and multivariate logistic regression.
Results:
A total of 170 SEEG insertion procedures were included in the study from 6 different level 4 pediatric epilepsy centers. The mean patient age at time of SEEG insertion was 12.3 ± 4.7 years. There was no significant difference between the mean age at the time of SEEG insertion between centers (p = 0.3). The mean number of SEEG trajectories per patient was 11.3 ± 3.6, with significant variation between centers (p < 0.001). Epileptogenic loci were identified in 84.7% of cases (144/170). Patients in 140 cases (140/170, 82.4%) underwent a follow-up surgical intervention, with 47.1% (66/140) being seizure free at a mean follow-up of 30.6 months. An overall postoperative hemorrhage rate of 5.3% (9/170) was noted, with patients in 4 of these cases (4/170, 2.4%) experiencing a symptomatic hemorrhage and patients in 3 of these cases (3/170, 1.8%) requiring operative evacuation of the hemorrhage. There were no mortalities or long-term complications.
Conclusions:
As the first multicenter case series in pediatric SEEG, this study has aided in establishing normative practice patterns in the application of a novel surgical technique, provided a framework for anticipated outcomes that is generalizable and useful for patient selection, and allowed for discussion of what is an acceptable complication rate relative to the experiences of multiple institutions.
