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The impact of skull thickness on pediatric stereoencephalography electrode implantation and technical considerations
Ansh Desai1, Akshay Sharma2, Swetha J Sundar2
11Case Western Reserve University School of Medicine, Cleveland.
Insights
Pediatric stereoencephalography (SEEG) is safe in patients 12 and under, with low complication rates. Thin skulls may require alternative electrode fixation methods like scalp suturing for improved accuracy.
Area of Science:
- Neurosurgery
- Pediatric Neurology
- Medical Devices
Background:
- Pediatric stereoencephalography (SEEG) presents unique challenges due to thinner skulls in children compared to adults.
- Traditional bolt-based electrode anchoring may be limited in pediatric patients.
Purpose of the Study:
- To evaluate the safety, complication rates, and technical adaptations for SEEG electrode placement in pediatric patients.
- To assess the impact of skull thickness on SEEG lead accuracy in children.
Main Methods:
- Retrospective review of SEEG implantation in 53 patients aged 12 years or younger.
- Measurement of postimplantation skull thickness and lead accuracy using CT scans.
Main Results:
- Median skull thickness was 4.1 mm.
- A 1.9% hardware complication rate and 9.4% asymptomatic hemorrhage rate were observed.
- Thicker skulls showed a trend towards improved lead accuracy, though not statistically significant.
Conclusions:
- Pediatric SEEG (12 years or younger) demonstrates a favorable safety profile.
- Suturing electrodes to the scalp is a viable alternative for cases with thin skulls or young age.
- Invasive SEEG evaluation is deemed safe for this pediatric cohort.
Objective:
One consideration in pediatric stereoencephalography (SEEG) is decreased skull thicknesses compared with adults, which may limit traditional bolt-based anchoring of electrodes. The authors aimed to investigate the safety profile, complication rates, and technical adaptations of placing SEEG electrodes in pediatric patients.
Methods:
The authors retrospectively reviewed all patients aged 12 years or younger at the time of SEEG implantation at their institution. Postimplantation CT scans were used to measure skull thickness at the entry point of each SEEG lead. Postimplantation lead accuracy was also assessed.
Results:
Fifty-three patients were reviewed. The median skull thickness was 4.1 (interquartile range [IQR] 3.15-5.2) mm. There were 5 total complications: 1 retained bolt fragment, 3 asymptomatic subdural hematomas, and 1 asymptomatic intracranial hemorrhage. Median radial error from the lead target was 3.5 (IQR 2.24-5.25) mm. Linear regression analysis revealed that increasing skull thickness decreased the deviation from the intended target, implying an improved accuracy to target at thicker skull entry points; this trended towards improved accuracy, but did not achieve statistical significance (p = 0.54).
Conclusions:
This study found a 1.9% hardware complication rate and a 9.4% asymptomatic hemorrhage rate. Suturing electrodes to the scalp may represent a reasonable option if there are concerns of young age or a thin skull. These data indicate that invasive SEEG evaluation is safe among patients 12 years old or younger.
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