Stereo-electroencephalography practices among pediatric and adult epilepsy surgeons: a survey study

Stereoelectroencephalography (sEEG) was introduced in Europe and has since been widely adopted throughout the United States during the past decade. Given the short history of its use in the United States, most neurosurgeons have not received dedicated sEEG training during residency. Instead, the majority learn sEEG techniques and practices as faculty and attendings. Because of the positively reported safety and efficacy profile of sEEG, it is a valuable tool for discerning epileptogenic foci. However, there are no consensus statements regarding surgical techniques and common intra-/perioperative practices. Here, the authors present the results of a survey of epilepsy neurosurgeons, providing data on current practices. They describe both comparable and contrasting results, indicative of a lack of standardized practice, and offer new insights not previously reported.

A digital survey with 49 questions was distributed to pediatric and adult epilepsy neurosurgeons via three different forums. The survey addressed multiple topics, including training; planning; techniques; perioperative use of antibiotics, steroids, and antiseizure medications (ASMs); and return-to-work or return-to-school protocols.

Fifty-four epilepsy neurosurgeons completed the survey. Consistent with previous surveys, most respondents (67.4%) reported a total of 1-25 sEEG procedures conducted at their institution annually, with the majority (93.6%) using a robotic system for electrode placement. There is typically a 1- to 6-month waiting period between sEEG and therapeutic procedures, such as placement of a responsive neurostimulation device, laser ablation, or open resection (85.7%, 77.5%, and 73.3% of respondents, respectively). Eighty percent of respondents reported that post-sEEG asymptomatic hemorrhage occurs 25% or less of the time, and 80% reported that post-sEEG infection never occurs, consistent with the literature. This survey is distinguished from others by reporting data on perioperative antibiotic, steroid, and ASM use, revealing substantial variability in antibiotic prescription schedules. Most respondents (77.3%) do not prescribe postoperative steroids, and 40% of respondents typically do not instruct patients to stop or decrease ASMs before admission (25% or less of the time). More than half of respondents (53.3%) reported instructing their patients to return to work or school between 1 week and 1 month post-procedure.

Stereo-EEG has seen a rapid increase in use during the past decade. However, widespread consensus surrounding techniques and practices is still lacking. This survey contributes new insights and data to the limited existing literature, enhancing understanding of important decision-making processes within the sEEG community.